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THE SKIN CANCER TIPPING POINT: ARE WE THERE YET?

05-17-16 | Posted by Denise Mann

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Unlike many other diseases, we know what causes the majority of skin cancers –exposure to the sun’s damaging ultraviolet (UV) rays. Despite this, skin cancer treatments ranked as the most commonly performed procedures by American Society for Dermatologic Surgery members in 2015 for the fourth year in a row – confirming the growing incidence of this disease.

What gives?

ASDS.NET

The numbers of new cases may be rising, but many dermatologists are cautiously optimistic that we are making slow and steady progress on all fronts and are nearing the skin cancer tipping point.

Here’s why:

New Treatments

Immunotherapy is a new class of cancer treatments that works by stimulating our immune system to fight cancers, including melanoma, the potentially fatal form of skin cancer. For years, the pipeline of drugs that could treat this cancer once it was on the move was anemic at best. Now, there are a host of immunotherapy drugs that are already US Food and Drug Administration (FDA)- approved to treat melanoma. (Former U.S. President Jimmy Carter has immunotherapy drugs to thank for saving his life. He was diagnosed with metastatic melanoma in his ninth decade and is now cancer-free.)

Targeted therapies are another new category of melanoma drugs. “We now know that there are targetable genetic changes in the melanoma tumor that are drugable and we have the drugs,” says Joanne Jeter, MD at The Ohio State University Comprehensive Cancer Center in Columbus, Ohio.” “These treatments, which include BRAF inhibitors, helped improve survival in people who have these genetic mutations.”

These therapies do fall short of a cure, but when awareness and prevention efforts are factored in, we are gaining the upper hand, she says. Prevention and early diagnosis will always be the key as when it’s caught early, melanoma is almost 100% curable, Jeter says.

Melanoma isn’t the only type of skin cancer that has gotten better treatments in recent years, adds Rebecca Tung, MD, an associate professor of medicine
and the Division Director of Dermatology at Loyola University’s Stritch School of Medicine in Chicago. “There are now topical treatments for basal cell and squamous cell skin cancers that do a better job of clearing smaller tumors in cosmetically sensitive areas, eliminating the need for surgery in many cases.”

Risk Reduction 2.0

The use of sunscreen and other sun-safety practices are the cornerstone of any skin cancer risk reduction strategy, but there are other measures that can also further the cause.

The FDA recently greenlighted a combination topical prescription drug Ameluz (BF-200 ALA) and medical device BF-RhodoLED for photodynamic therapy treatment of mild-to-moderate actinic keratosis (AK) on the face and scalp. AK’s are caused by damage from the sun’s rays. They are often elevated, rough in texture, and resemble warts.  Some are red, and some will be tan, pink, and/or flesh-toned. If left untreated, up to ten percent of AKs will turn into squamous cell carcinoma, the Skin Cancer Foundation reports.

What’s more, “some of the same resurfacing tools that we use to rejuvenate skin can also take off sun damage and pre- cancerous lesions like AKs,” Tung says. “Lasers and chemical peels can renew the top level of skin and give people a fresh start.”

New York City dermatologist Gary Goldenberg, MD, medical Director of the Dermatology Faculty Practice at The Mount Sinai Medical Center, and an Assistant Clinical Professor of Dermatology at The Mount Sinai School of Medicine in New York City, agrees. “We do have more tools to treat skin cancer. This isn’t just with melanoma, therapy of which has improved especially in advanced patients. We now have more options for patients with precancerous lesions and non-melanoma skin cancer.”

Life-saving Apps.

Smart phone apps can do more than allow you to brighten your teeth or smooth your skin, some help spot skin cancer early – and may even save your life. “Apps allow us to take pictures of moles and keep track of any changes,” Jeter says. Will apps ever take the place of a visit to the dermatologist? No, but they can certainly help get many people there sooner, she says. Some apps use big data to foster an earlier diagnosis of skin cancer. DermaCompare, for one, allows users to transmit total body images to dermatologists in real time. The app culls large volumes of information on all sorts of moles that can be readily accessed by doctors to determine if yours is cancerous or likely to become cancerous. “I have never seen anything like DermaCompare. I believe their ability to combine the power of artificial intelligence with the utility of a mobile app will revolutionize the way we detect and diagnose melanoma,” says Perry Robins, MD, Professor Emeritus of Dermatology and was Chief of the Mohs Micrographic Surgery Unit at New York University Medical Center for more than forty years, in a news release. Dr. Robins is on the company’s advisory board.

Powerful Public Awareness Campaigns

Public Awareness campaigns – some at the grass roots levels and others that harness the power of social media and clever hashtags – are also getting the skin cancer prevention message out. Some campaigns put names and faces on the disease while others provide free screenings and others still reinforce prevention messages. The American Cancer Society’s awareness campaign for skin cancer prevention promotes the slogan “Slip! Slop! Slap! and Wrap” reminds people of the four key ways they can protect themselves and their children from UV radiation: Slip on a shirt, Slop on sunscreen, Slap on a hat and Wrap on sunglasses to protect your eyes and sensitive skin around them.

The American Academy of Dermatology encourages everyone to make sure their skin is #LookingGoodin2016 by protecting it from the sun’s ultraviolet rays and checking it for signs of skin cancer. This year’s campaign is honing in on men who may not be as aware of the importance of sun protection and the dangers of tanning as women. “The public awareness component has been huge,” says Tung.

Now, it’s time to go after outlier populations like men and people with skin of color who may not be getting the message as loud or as clear, she says.

“Many of our patients don’t know that they are at risk and they don’t know what skin cancer looks like yet,” she says. “Then there are those who know what they should be doing but they don’t necessarily do it,” she says. “Knowledge is power, but implementation is very important as well.” These types of campaigns have made a tremendous dent in skin cancer rates in Australia – once the skin cancer capital of the world. “Our public awareness campaigns have driven home the importance of sunscreen and early detection,” says Michelle Rodrigues, MD, a consultant dermatologist at St. Vincent’s and the Royal Children’s Hospital in Melbourne Australia. “ While melanoma is still extremely common here, the vast majority are now diagnosed in the early stages and that is heartwarming to know,” she says. The earlier melanoma is diagnosed and treated, the greater the chance for a cure, she says.

Celebrity CounterCulture

Gigi Hadid (and Bella), Blake Lively, Olivia Culpo, Charlize Theron … The list of celebrities with flawless, alabaster complexions goes on. Gone are the days when celebrities sported that bronze, sun-kissed look on covers of magazines and while doing the catwalk.

“We don’t see celebrities with skin the color of deep mahogany from tanning anymore,” Tung says. “This is a good thing as we tend to emulate celebrity trends.”

#Banthetan Legislation

Many states have taken steps to ban the use of indoor tanning among minors, and the FDA is also pushing this needle forward as well as calling tanning bed manufacturers to task regarding the overall safety of these devices. “This is sending a good message to young people,” Tung says.“If we can get our youth to not be into tanning, there is going to be reduction in the skyrocketing numbers of skin cancer.”