Monday Medical: New technology for early detection of skin cancer
Melanoma, the most dangerous type of skin cancer, is becoming more and more common. But with advances in early detection and treatment, it’s easier than ever to be proactive in your care.
“The incidence of melanoma has steadily increased for the past 30 years, and it is increasing more rapidly in young, white women in recent years,” said Dr. Maryann Wall, who is board certified in otolaryngology, head and neck surgery and facial plastic and reconstructive surgery. “And we don’t have great options for advanced-stage disease. Prevention and early detection of melanoma is a key factor in improving patient survival.”
The first advancement in early detection may be sitting in your back pocket: your smartphone.
Apps now allow people to photograph and measure new or changing moles and lesions. Many of Wall’s patients use their phones to track possible skin issues. Sometimes, they’ll email Wall a photo of a concerning spot so she can determine whether an appointment or close monitoring is the best immediate step.
“Any time you participate in your own care, that’s going to benefit both sides of the relationship between physician and patient,” Wall said. “It’s going to make you more aware of your skin and take better care of your skin.”
But not all apps are created equal: Wall discourages the use of melanoma detection apps that evaluate photos of the skin through algorithms or doctors’ opinions. If an app misses an actual melanoma, the results could be devastating.
“The accuracy rate is just too low,” Wall said. “We don’t want patients trying to diagnose their own melanoma with these smartphone apps … You’d be missing too many.”
Another advancement is tailoring the treatment for early stage melanoma based on the presence of certain genetic mutations.
Melanoma occurs when there are genetic mutations in the pigment-producing cells of the skin. With stage I or II melanoma, the usual course of action is to remove the primary tumor and follow up with routine skin exams.
But about 14 percent of people with early stage melanoma are at risk for metastatic disease and need more aggressive treatment, Wall said. By looking at the specific genetic mutations in the tumors, doctors can now determine which patients have a higher risk of metastasis and treat them accordingly.
“It’s a way to avoid under-treatment relative to their risk,” Wall said. “(It’s) more an approach of personalized medicine.”
Still another advancement is how immunotherapies are being used to treat stage IV melanoma, said Dr. Allen Cohn, a medical oncologist at Yampa Valley Medical Center and Rocky Mountain Cancer Centers.
In many melanomas, a BRAF mutation produced in an altered protein that causes melanoma cells to grow and divide quickly. For these cases, drugs called BRAF inhibitors can be used to shrink and slow the cancer.
If the BRAF mutation isn’t present, checkpoint inhibitors can be used.
“The immune system is very tightly regulated,” Cohn said. “What these checkpoint inhibitors do is they take the … brakes off the immune system so the immune system can become more active and help to fight the cancer.”
In both cases, the immunotherapy drugs have fewer side effects and more success than chemotherapy, Cohn said.
Melanoma detection and treatment is changing very rapidly, with new advancements coming out all the time — including the possibility of a melanoma vaccine treatment. But prevention is still key, Cohn said.
“The important thing is to avoid sun, use sunscreen and apply it often and get skin exams every year.”
Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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