Recently held, World Cancer Day 2015 took ”a positive and proactive approach to the fight against cancer.” I was thrilled when the opportunity came about for me to ask some questions, and get the viewpoint regarding skin cancer and melanoma from:
Joel M. Schwartz, DO
Board Certified in Radiation Oncology
Illinois Cancer Specialists, a practice in The US Oncology Network
Here is my interview with Dr.Joel M.Schwartz:
#1: VICKI: Dr. Schwartz, a lot of people want to know: what is melanoma and who is prone to getting this type of cancer?
DR. SCHWARTZ: Each year there are more new cases of skin cancer than breast, prostate, lung and colon cancers combined. Melanoma is the most dangerous form of skin cancer. There are about 120,000 new cases of melanoma each year and melanoma kills an estimated 9,710 people in the U.S. annually. These tumors originate in the pigment-producing melanocytes. Melanomas often resemble moles and some develop from moles.
There are several factors that can put someone at a higher risk of developing a melanoma.
• Early sun exposure – a research study involving nurses reported in 2014 found that white women who get five or more blistering sunburns between the ages of 15 and 20 have an 80 percent increased risk for melanoma.
• Tanning bed usage – A 2014 study estimated that more than 400,000 cases of skin cancer may be related to indoor tanning in the United States each year—causing 245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6,000 melanomas. http://www.ncbi.nlm.nih.gov/pubmed/24477278
• Moles – atypical moles, (also known as dysplastic nevi) can be precursors to melanoma, the more moles you have, the greater your risk for melanoma.
• Skin type – Fair-skinned people are at much greater risk than those with darker skin. This is because darker skinned people produce more melanin, the pigment that gives color to skin and hair, and protects the skin from damage from ultraviolet radiation.
• Eye and hair color – people with blue or green eyes and red hair or blond hair are at increased risk for developing melanoma.
• Genetics – About one in every 10 patients diagnosed with the disease has a family member with a history of melanoma. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history of the disease. A person with both an atypical mole and a family history of melanoma is at “high risk” for melanoma.
#2 VICKI: Other than melanoma, are there other types of skin cancers people should be aware of? How common are they?
DR. SCHWARTZ: The most common types of skin cancers are Basal Cell Carcinomas (BCC) and Squamous Cell Carcinomas (SCC). They are much more common than melanoma. Basal cell carcinoma is the most common form of skin cancer with an estimated 2.8 million diagnosed annually in the U.S. Squamous Cell Carcinoma is the 2nd most common form of skin cancer. An estimated 700,000 cases of SCC are diagnosed each year in the U.S. About 2% percent of SCC patients – between 3,900 and 8,800 people – died from the disease in the U.S. in 2012.
#3 VICKI: What are the common warning signs and symptoms that people should bring to their doctor’s attention?
DR. SCHWARTZ: For melanoma, there are the classic “ABCDE signs.”
This includes moles with:
• Uneven Borders
• Multiple Colors
• A Diameter greater than an eraser
• An Evolving or changing appearance
Also, any mole that appears to be different or is changing differently than other moles, may be a warning sign for melanoma (this is referred to as The “Ugly Duckling” sign).
With regard to BCC and SCC , these cancers often appear as:
• An open sore that does not heal
• A shiny-pearly bump
• A pink bump with edges that are rolled in appearance
#4 VICKI: Why do malignant skin lesions and other skin spots seem to suddenly appear as people get older?
DR. SCHWARTZ: As people age, two things happen. First, the body becomes less able to police itself and correct genetic mistakes (i.e. mutations) which occur all the time as the body is making new cells. Since the body of an older person is less savvy at correcting these genetic mistakes, they are more likely to survive, become incorporated into our bodies and develop into cancers.
In addition, sun cumulative exposure is a risk factor for skin cancer. The longer a person lives, the more sun exposure he/she has and the possibility of developing skin cancer increases as well.
#5 VICKI: Other than regular use of sun protection, are there any other preventatives that we can do to lessen the chance of getting skin cancer?
DR. SCHWARTZ: This is a very interesting topic since risky and voluntary over-exposure to the sun (or a tanning bed) is very preventable. This is particularly concerning regarding teenagers and young adults. With regards to the prevention of skin cancer, I believe society has a real responsibility to help individuals enhance their self-esteem and thereby help people appreciate their unique, tremendous inner value.
There is a growing body of evidence that for many people, tanning has become an addiction.
Like other addictions, it is often associated with:
• A desire to escape
• A dissatisfaction with one’s self-image
Research suggests that this self-destructive behavior (i.e. excessive sun or tanning bed exposure) is correlated with low self-esteem scores and an unhealthy self-image. http://www.mmu.ac.uk/news/news-items/2948/
By helping people improve their self-esteem, an individual’s obsession with a “beautiful dark tan” will hopefully be replaced by solid feelings of inner self-worth and a life of purpose and meaning. As I see it, improving someone’s self-esteem is an important avenue of skin cancer prevention.
#6 VICKI: That certainly is a very interesting point, Dr. Schwartz! Are there any new medical breakthroughs in dealing with melanomas or skin cancers?
DR. SCHWARTZ: For a long time, we have known that early-stage melanoma can usually be cured with surgery. With regard to more advanced and metastatic melanomas, the prognosis had been much more bleak.
In the last few years however, we have seen enormous breakthroughs in the area of new pharmaceuticals for advanced melanoma. This includes drugs which are targeted to specific genetic mutations (i.e. BRAF inhibitors and MEK inhibitors) which attempt to “turn off” the growth process within melanoma tumors.
Another group of new drugs are “immunotherapy” drugs. These medicines (T-cell simulators and anti-PD1 agents) try to activate and recruit the body’s own immune system to recognize and to destroy melanoma tumors.
In the area of BCC and SCC, surgery has also been the traditional mainstay of therapy (with a 90-98% cure rate). An exciting new area of treatment for BCC and SCC is non-surgical Skin HDR radiotherapy. Skin HDR treats BCC and SCC with a tiny radioactive seed that briefly rests on top of the skin cancer. These treatments are fast (5-10 min), they are precisely targeted and very effective (they have a 90-95% cure rate).
Since these treatments are non-invasive there are no surgical scars, they require no anesthesia, and there is no need for subsequent plastic surgery to repair a hole left by prior cancer surgery.
Recent research indicates that surgeons commonly underestimate the importance which patients attribute to their appearance. This same researcher has found that <strong>scars (especially on the face) tended to have a negative impact on patients’ psychosocial functioning.
I believe that surgery will always be used for the treatment of BCC and SCC. In the current era of “minimally invasive procedures”, Skin HDR offers people an effective and less disfiguring skin cancer treatment option.
#7 VICKI: Dr. Schwartz, would you recommend that your family physician, internist, or PCP provide regular skin check-ups? Should you ask for a referral if they do not provide them, and how often should you have your skin checked?
• Multiple moles
• Atypical moles
• A history of melanoma
• A 1st degree relative with melanoma
• A known genetic predisposition for melanoma should perform self-examinations and should be checked regularly by a Dermatologist. Dermatologists have special tools and training to track and follow patients at high risk for skin cancers. These tools include Dermatoscopy and Total Body Photography.
At this point, the CDC and the US Preventative Task Force have concluded that there is not enough evidence to recommend for or against routine screening (total body examination by a doctor) to find skin cancers early.
In my experience, patient’s always know their bodies better than anyone else. If a person feels that he/she has a skin lesion that has changed or is acting strangely, I believe that one should trust their instincts and have it evaluated.
#8 VICKI: Is there anything else that you’d like to share? This a very important and interesting topic.
DR. SCHWARTZ: Medicine is entering a new era that demands a more holistic approach to patient care. The field of skin cancer treatment is certainly no different. Physicians need to use the best, state-of-the-art-treatments to target and cure skin cancers. This is just the tip of the iceberg however. We also need to be looking for the root causes and behaviors that promote skin cancers. We need to spend more time focused on “preventative medicine” (including sunscreen education, tanning bed education, taking preventative medicines such as aspirin, as well as providing psychological support and addiction support to our patients when necessary). We need to do dietary assessments of our patients and provide advice for supplementation (i.e. Vitamin D supplementation) when necessary. In addition, patients are looking for treatments that are less invasive and less destructive. Just as the lumpectomy has allowed women with breast cancer to avoid the disfigurement of a mastectomy, some patients with skin cancer will benefit from the completely non-surgical treatment delivered with Skin HDR.
I believe that a holistic approach in medicine should attempt to leave every person as whole as possible.
We know that skin cancer patients aren’t always given all of their treatment options. http://archinte.jamanetwork.com/article.aspx?articleid=1785955#.VLsTb7GwLZ0.twitter
Accordingly, I feel a responsibility to provide my patients with ALL of their treatment options including options which allow them to keep their entire ear, nose, finger, etc.
“Survivorship” is a new word in the lexicon of cancer medicine and it is a very important word in the eyes of patients. It’s a term that describes how each person is going to live and survive with the lifelong effects of their cancer and with the effects of their cancer treatment.
Survivorship has to be important to physicians too!
VICKI: Thank you, Dr. Schwartz, for taking time to provide the readers with such valuable information and websites to further educate, empower, and expand their cancer awareness regarding Skin Cancer, Melanoma and “Survivorship”!
For more information about Dr.Joel Schwartz visit:
(Commentary and websites within this interview were provided by Dr.Joel Schwartz. Quoted Reference to World Cancer Day, and additional data at: http://www.worldcancerday.org)