05 November 2018
MONDAY, Nov. 5, 2018 (HealthDay News) — Melanoma skin cancer death rates in men are on the rise in most countries, but are stable or declining for women in some, according to a new study. Researchers analyzed World Health Organization data from 33 countries between 1985 and 2015. Melanoma death rates in men were increasing in all but one nation. In all 33 countries, melanoma death rates were higher for men than for women, the study found. Between 2013 and 2015, the highest three-year averages were in Australia (5.72 melanoma deaths for every 100,000 men and 2.53 per 100,000 in women) and in Slovenia (3.86 per 100,000 for men and 2.58 in women). Japan had the lowest rate of melanoma deaths, 0.24 per 100,000 for men and 0.18 for women, researchers reported. The Czech Republic was the only country with a decrease in men’s melanoma death rate, with an estimated annual drop of 0.7 percent between 1985 and 2015. Israel and the Czech Republic had the largest decreases among women, 23.4 percent and 15.5 percent respectively, over the period, according to the study. The findings are being presented at the United Kingdom’s National Cancer Research Institute (NCRI) annual conference, in Glasgow, Scotland, Nov. 4-6. More research is needed to understand factors underlying the trends, according to study author Dr. Dorothy Yang, a doctor at the Royal Free London NHS Foundation Trust. “There is evidence that suggests men are less likely to protect themselves from the sun or engage with melanoma awareness and prevention campaigns. There is also ongoing work looking for any biological factors underlying the difference in mortality rates between men and women,” Yang said in a meeting news release. “The major risk factor for melanoma is overexposure to ultraviolet radiation, either from sun exposure or from using sunbeds. Despite public health efforts to promote awareness of melanoma and encourage sun-smart behaviors, melanoma incidence has been increasing in recent decades,” she said. Poulam Patel, chairman of the NCRI Skin Cancer Clinical Studies group, said effective strategies are needed to accurately diagnose and successfully treat patients. The study results suggest melanoma will continue to be a health issue, he said. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal. More information The U.S. National Cancer Institute has more on melanoma.
23 August 2018
THURSDAY, Aug. 23, 2018 (HealthDay News) — A combination of two drugs that work with the immune system can help beat back melanoma that has moved to the brain, an early clinical trial has found. The study included 94 patients with advanced melanoma that had invaded the brain. All were treated with two “immunotherapy” drugs — Opdivo (nivolumab) and Yervoy (ipilimumab) — which help the immune system find and destroy tumors. Overall, 57 percent of the patients saw their brain tumors disappear, shrink or remain stable for at least six months. For most, the responses were still evident at their latest follow-up, at the 14-month mark. And after one year, more than 80 percent of all patients were still alive. “That’s really tremendous,” said lead researcher Dr. Hussein Tawbi, of the University of Texas M.D. Anderson Cancer Center in Houston. “Without treatment, that rate would be about 20 percent.” Experts said the findings represent another step forward against advanced melanoma, the deadliest form of skin cancer. Once melanoma spreads to distant sites in the body, the prognosis has traditionally been grim. When it infiltrates the brain, the typical life expectancy has hovered around four to five months, according to Tawbi. But in recent years, several new drugs have been approved to fight advanced melanoma. They include Opdivo and Yervoy, which are already used in combination. The drugs belong to a group of immunotherapies called checkpoint inhibitors. They essentially free up immune-system T-cells to seek and destroy tumor cells. But major trials of the drugs, Tawbi said, have excluded patients with brain metastases (melanoma that has spread to the brain). Right now, he said, the typical treatment for those patients is surgery to remove the tumors, if possible, as well as radiation. Then they might receive immunotherapy drugs. Tawbi’s team took a different approach: They used Opdivo and Yervoy as a first-time treatment for patients with brain metastases that were discovered during MRI scans. All received infusions of both drugs every three weeks, for up to four doses. After that, they continued with Opdivo infusions every two weeks, until their cancer progressed or the side effects became too toxic. Opdivo maker Bristol Myers-Squibb partially funded the trial. “Our first concern was whether it would be safe,” Tawbi said. One worry was that if T-cells flooded the brain to attack the cancer, it would cause dangerous brain inflammation. But, Tawbi said, the side effects were similar to what’s seen in melanoma patients without brain metastases. Most often, that meant fatigue, diarrhea, nausea and increases in liver enzymes that can indicate liver damage. One patient died of a heart complication blamed on the treatment. And 20 percent went off the drugs because of severe side effects. As for the benefits, 26 percent of patients saw their brain tumors disappear. Tumors shrank in another 30 percent, and two patients remained stable for at least six months. The overall survival rate at one year was 81.5 percent. “That’s exactly what you’d expect to see in patients without brain metastases,” said Dr. Mario Sznol. Sznol is a melanoma expert with the American Society of Clinical Oncology, and co-directs the cancer immunology program at Yale Cancer Center in New Haven, Conn. He said the findings suggest that many patients with brain metastases can skip radiation — and its side effects — and go straight to immunotherapy. That’s not true of all patients, stressed Sznol, who was not involved with the study. The trial did not include people with large brain tumors, for example — which may require surgery and radiation first. The immunotherapy drugs do have a high rate of side effects, Sznol noted, but those problems are usually medically manageable. The drugs are also very pricey: The list price for the first year of therapy with both tops $250,000. But on balance, Sznol said, “I think the risk-benefit ratio falls in favor of treatment.” A couple of small trials have tested the effects of Opdivo or Yervoy alone in patients with brain metastases, but only about one-quarter responded, according to Tawbi. So, he said, the combination appears more effective. Sznol said the findings offer a hopeful message to patients. “It’s becoming a myth that melanoma patients with brain metastases will do poorly,” he said. “Some will. But that’s not necessarily the case anymore.” The study was published Aug. 23 in the New England Journal of Medicine. More information The American Society of Clinical Oncology has more on immunotherapy for melanoma.
09 August 2018
THURSDAY, Aug. 9, 2018 (HealthDay News) — People who have frequent recurrences of a common skin cancer may be at increased risk of a range of other cancers, a new study suggests. Researchers found the heightened risk among patients who’d had many bouts of basal cell carcinoma (BCC) — a highly treatable form of skin cancer diagnosed in over 3 million Americans each year. Patients who’d developed at least six BCCs over 10 years showed higher-than-average risks of breast, colon, prostate and blood cancers. It’s well known that people who develop any form of skin cancer face an increased risk of other skin cancers — including the most serious form, melanoma. “This study shows that when people have frequent basal cell carcinomas, they also have an increased risk of internal cancers — which hasn’t been seen before,” said lead researcher Dr. Kavita Sarin. Basal cell carcinoma, which is caused mainly by ultraviolet (UV) exposure, is highly curable. And the vast majority of people do not develop it at the frequency linked to internal cancers, according to Sarin, an assistant professor of dermatology at Stanford University. She said her team’s findings suggest that when people do have such frequent recurrences, it may signal an underlying susceptibility to cancer more generally. For the study, the researchers analyzed the DNA of 61 patients with frequent basal cell carcinomas, and found 20 percent had mutations in genes that help repair DNA damage in body cells. Cancer arises when such abnormal cells grow and spread unchecked. “That 20 percent figure is much higher than you’d see in the general population,” Sarin said. She cautioned, though, that the finding is based on a small group of patients, and further research is necessary. Dr. Vernon Sondak, who heads the skin cancer department at Moffitt Cancer Center, in Tampa, Fla., called the findings important, though not surprising. It has long been thought that the skin can serve as a “tip off” that a person is relatively more vulnerable to DNA damage from various exposures. “This suggests that the same underlying biology that makes some people especially vulnerable to DNA damage from UV radiation may also make them more susceptible to other cancers,” said Sondak, who was not involved in the study. People who have a history of frequent BCCs should be sure to get the recommended screenings for other cancers, like breast and colon cancers, Sondak said. And if they have a strong family history of any of those internal cancers, he noted, they might talk to their doctors about whether screening at an earlier age is a good idea. Sarin agreed, and said that in some cases, genetic testing might be suggested. The study findings are based on the 61 patients at Stanford who’d been treated for an unusually large number of BCCs — an average of 11 times over 10 years. More than one-third of them had a history of other cancers, too. Among patients with at least six basal cell carcinoma diagnoses, the risks of blood, breast, colon and prostate cancers were roughly three- to six-times higher, versus the norm for Americans of the same age and race, the study authors reported. The researchers then confirmed the pattern using a health insurance database with information on over 111,000 BCC patients. Again, people with frequent basal cell carcinomas had increased risks of internal cancers, including blood and colon cancers. Among the Stanford patients, 20 percent had mutations in any of a dozen genes involved in DNA repair — including the BRCA genes linked to breast and ovarian cancers. In contrast, that would be seen in about 3 percent of the general population, according to Sarin. What about the other 80 percent of patients? Sarin said it’s possible other groups of genes — like tumor-suppressor genes — are involved. She and her colleagues are continuing the study and will be looking at that. Another question, Sarin said, is whether the same pattern is true of people with frequent recurrences of squamous cell carcinoma — another common, highly curable skin cancer. For now, she stressed that the higher cancer risk was seen only when people had frequent BCC diagnoses. “This doesn’t apply to you if you’ve had one or two basal cell carcinomas,” she said. The findings were published online Aug. 9 in the journal JCI Insight. More information The American Academy of Dermatology has more on basal cell carcinoma.
27 July 2018
FRIDAY, July 27, 2018 (HealthDay News) — Gym rats are trying to get healthy. So why do so many U.S. gyms have tanning beds, researchers want to know. Since indoor tanning raises the risk of skin cancer, this common combo sends a conflicting message to gym users, University of Connecticut researchers say. “By pairing exercise with tanning beds, gyms send the message that tanning is part of a healthy lifestyle. It is not,” said study author Sherry Pagoto. She’s a professor of allied health sciences. Pagoto and her colleagues surveyed more than 600 people who had used a tanning bed at least once in their life. Nearly one-quarter had tanned in a gym at least once, the findings showed. Those who had tanned at a gym tended to be heavier tanners overall, and were more likely to be what the researchers called “addictive” tanners. Tanning more often was associated with more frequent exercise, which is especially concerning, because of the association between heavy exercise and skin cancer risk, according to the authors. It’s not clear why more exercise is associated with an increased risk of skin cancer. “Exercise and tanning are both things people use to look better, which may be why we see a connection between these two behaviors, and why gyms are providing tanning beds to patrons,” Pagoto said in a university news release. However, “indoor tanning is the same class of carcinogen as tobacco, radon and arsenic,” Pagoto said. “Those are not things you’d want around you while you’re working out.” Ongoing, occasional use of tanning beds triples a person’s lifelong risk of melanoma, the deadliest type of skin cancer, according to the Melanoma Research Foundation. The study was published July 18 in JAMA Dermatology. More information The U.S. Centers for Disease Control and Prevention has more on the dangers of indoor tanning.
26 July 2018
THURSDAY, July 26, 2018 (HealthDay News) — Karolina Jasko was a high school senior when a nail salon worker pointed out the black vertical line on her right thumbnail. Because she typically painted her nails, the black line had gone unnoticed and unheeded, but then it started to show signs of infection. At that point, Jasko sought out medical advice and got her diagnosis: a melanoma of the nail. “My mom was freaking out even more than I was, I think, because she had melanoma before, so she knew what it was like,” said Jasko, who’s now a student at the University of Illinois at Chicago, as well as the current Miss Illinois USA 2018. That diagnosis led to three surgeries and the eventual loss of the nail, but luckily, not the thumb itself. “I’m a little self-conscious about it, but I was lucky,” Jasko said. “The doctors originally thought they would have to remove my whole thumb, and you never realize how much you use your right thumb until you think about losing it.” And she knows it could have been a lot worse. “If I had waited any longer to see a doctor and have my first surgery, the melanoma could have spread through my whole body,” Jasko said. Melanoma, the deadliest form of skin cancer, can occur anywhere in the body — including in your nails. And, as it happened with Jasko, nail melanoma is commonly overlooked, according to Dr. Shari Lipner, a New York City dermatologist. Because of this, patients may face amputation of the affected toe or finger or even death, Lipner said in an American Academy of Dermatology news release. “It’s important to regularly examine your whole body for signs of melanoma and other skin cancers, and that includes your nails,” she added. Unlike melanoma of the skin, ultraviolet radiation exposure is likely not an important risk factor for nail melanoma. The two main risk factors for nail melanoma are previous nail trauma and a personal or family history of melanoma, Lipner said. Anyone can develop nail melanoma, but rates are higher among older individuals and people with skin of color. The main sign of nail melanoma is a brown or black band in the nail, often on the thumb or big toe, Lipner said. It’s usually on your dominant side. “Because early detection plays such a big role in nail melanoma prognosis, it’s important to keep an eye on your nails and be aware of any changes to them,” Lipner said. “If you notice a new dark band on your nail, or any band that is getting wider or darker, you should see a board-certified dermatologist as soon as possible.” There’s no reason to panic: Such discolorations can also be caused by other issues, such blood pooling under the nail due to injury or too-tight shoes, or a bacterial or fungal infection. But it’s best to have a dermatologist look at the affected nail to be sure. Other warning signs of a potential nail melanoma include dark pigment on the skin around the nail, splitting or bleeding of the nail, or infection-like symptoms such as drainage, pus and pain. As with other types of melanoma, any change to the nail is also an important warning sign. Jasko agreed: better safe than sorry. “People may not realize that you can get melanoma in your nails, but it’s important to be aware of that risk,” she said in the news release. “If you have the slightest concern about something on your nail, go and get it checked out by a dermatologist; it could end up saving your finger or your life.” More information SkinCancer.net has more on nail melanoma.
13 July 2018
FRIDAY, July 13, 2018 (HealthDay News) — Two years ago, Ian McKenzie thought his mom’s remaining days were dwindling. The 97-year-old woman had developed a severe case of what was thought to be an untreatable form of squamous cell carcinoma, the second leading form of skin cancer. Lesions had developed over much of her right leg, in such numbers and size that chemotherapy and surgery were ruled out as treatments. On a hunch, her doctor, Dr. Anna Nichols of the University of Miami’s Sylvester Comprehensive Cancer Center, tried an unorthodox approach — she injected each tumor with Gardasil, the HPV vaccine. The result: All the tumors completely and rapidly disappeared. Now cancer-free, McKenzie’s mother is getting ready to celebrate her 100th birthday this fall. “This outcome was more than what I had even hoped for,” her son said. “It was like the tumors were going through a dying phase, one by one.” No one is claiming that the outcome in this single case will translate to skin cancer patients generally. Still, McKenzie hopes his mom’s experience spurs more research. “I hope that this treatment can be further tested and used in clinical trials, as the benefit is just too practical to be ignored,” he said. The human papillomavirus (HPV) shot has already revolutionized the prevention of a wide range of cancers — cervical, genital, anal and oral — with which the virus has been strongly linked. But there’s been little study on its use as a treatment for existing tumors, said Nichols. She’s an assistant professor at the cancer center’s department of dermatology and cutaneous surgery. Nichols’ own research, involving two prior patients, had suggested the vaccine might curb skin cancer growth. So, in the new case, her team decided to try Gardasil as an “off-label” therapy — a use not yet approved by the U.S. Food and Drug Administration. Nichols first administered two vaccine doses in the woman’s arm. Several weeks later, additional injections were administered directly into some of her tumors. The treatment was applied a total of four times, spread out over an 11-month period. Less than a year following the initial direct-to-tumor vaccine injection, all of the treated tumors disappeared, Nichols said. What’s more, over the two-year post-treatment period, there’s been no skin cancer recurrence. “We were surprised that all of the patient’s tumors regressed,” said Nichols, “even those that were not directly injected with the HPV vaccine. This has never been reported until now.” Many questions remain, of course. More testing is planned to reconfirm the vaccine’s effectiveness against squamous cell carcinomas, Nichols said. It’s unclear if it will prove similarly effective against other forms of skin cancer. But Nichols believes that the HPV vaccine “could be considered for carefully selected patients who have limited conventional treatment options.” According to the American Cancer Society (ACS), squamous cell carcinoma accounts for roughly 20 percent of all skin cancer cases. The disease typically manifests in those areas of the body that are commonly exposed to the sun, such as the face, ears, neck, lips or hands. Surgery is normally the standard of care, Nichols and her team noted. But in cases where multiple lesions have developed, surgery is not always a realistic option. Dr. Len Lichtenfeld is deputy chief medical officer for the American Cancer Society. He said the “concept of injecting a vaccine or an infectious agent into a cancer tumor is not in and of itself new. What’s new is the use of the HPV vaccine. “And what likely has happened here,” he said, “is that by injecting it into the tumor cells the vaccine helped the patient’s own defense mechanism respond in such a way as to attack the cancer in that location. “That itself is a very important observation,” Lichtenfeld believes. “And it certainly is intriguing. And I suspect it’s one that’s going to be looked into further and quickly. Because these are cancers for which we don’t have much to offer, in this kind of a situation. “And if this is repeated on a larger scale, that would certainly be important for patient care,” he said. Ian McKenzie agreed. “This proved to me the power of immunizations and the role they play with the immune system,” he said. “Fighting cancer by making the immune system recognize the tumors seems so logical, and worth further exploration.” The case report was published earlier this month in JAMA Dermatology. More information Find out more about squamous cell carcinoma at the American Cancer Society.
12 July 2018
THURSDAY, July 12, 2018 (HealthDay News) — A type of therapy that harnesses the immune system is giving new hope to people battling a once hopeless cancer — melanoma that’s spread to the brain. New research involving more than 2,700 U.S. patients is confirming what specialists in the field have long known — that “checkpoint blockade” treatment can beat back these devastating tumors. “Physicians who treat patients with melanoma brain metastases have seen first-hand the dramatic improvements in survival that immunotherapy can achieve,” said one such specialist, Dr. Jason Ellis. “This study provides data to support our individual clinical observations,” said Ellis, a neurosurgeon at Lenox Hill Hospital in New York City. He wasn’t involved in the new study. Checkpoint blockade agents are not chemotherapy — instead of acting directly on tumor cells, they manipulate the patient’s immune system so that it targets and destroys the melanoma cells. This type of “immunotherapy” was approved by the U.S. Food and Drug Administration in 2011. The new research was led by Dr. J. Bryan Iorgulescu, a postdoctoral fellow in pathology at Brigham and Women’s Hospital/Harvard Medical School in Boston. His team explained that about one in every 54 Americans will develop a melanoma skin cancer in their lifetime. Luckily, most cases are detected early and easily cured via surgery. But sometimes the tumor has had time to spread, even to the brain. In fact, advanced melanomas are now the third-leading cause of metastatic brain cancer, the research team noted. In its analysis, Iorgulescu’s group tracked outcomes from 2,753 patients with melanoma that had spread to the brain. The patients were treated at cancer centers nationwide between 2010 and 2015. The study found that first-line treatment with checkpoint blockade immunotherapy was associated with a rise in median overall survival from 5.2 months to 12.4 months. Treatment was also tied to an increase in the four-year overall survival rate: Just over 28 percent of patients who got the immunotherapy survived at least four years, compared to about 11 percent who didn’t get the therapy, the findings showed. The researchers noted that survival benefits were even greater for those patients whose melanoma had not already spread beyond the brain, to organs such as the liver or lungs. “Our findings build on the revolutionary success of checkpoint blockade immunotherapy clinical trials for advanced melanoma, and demonstrate that their substantial survival benefits also extend to melanoma patients with brain metastases,” Iorgulescu said in a Brigham and Women’s news release. Dr. Michael Schulder helps direct neurosurgery at Long Island Jewish Medical Center in New Hyde Park, N.Y. He wasn’t involved in the new analysis, but agreed it confirms what many cancer specialists have long known, “namely, that the use of checkpoint inhibitors has revolutionized the treatment and outlook for patients with metastatic melanoma.” The Boston researchers did offer one caveat, however: Not every patient has equal access to this expensive treatment. Insurance status was a real barrier to immunotherapy for some patients with these advanced tumors, and uninsured patients were much less likely to get the treatment compared to people with private insurance or those on Medicare. The findings were published July 12 in Cancer Immunology Research. More information The U.S. National Cancer Institute has more on melanoma.
01 July 2018
SUNDAY, July 1, 2018 (HealthDay News) — When planning your Fourth of July outing, remember sun protection for youngsters. “It is imperative for parents to protect their children from the harmful effects of extreme sun exposure,” said Dr. Alberto Pappo, director of the Solid Tumor Division at St. Jude Children’s Research Hospital in Memphis, Tenn. Kids are not immune from cancer just because they’re young, Pappo emphasized. “While rare, melanoma is the most common type of skin cancer in younger patients and affects mostly teenagers. If diagnosed early, it can be treated effectively,” he said in a hospital news release. Pappo offered this sun-safety advice: Try to keep children indoors when the sun’s rays are strongest — between 10 a.m. and 2 p.m. They should avoid direct exposure to the sun’s UV rays as much as possible. No sun at all is best for infants under 6 months of age. You can take them outdoors, but keep them covered up. They need to wear a hat and cover their neck, arms and legs. Avoid sunscreen for babies under than 6 months of age to avoid exposing them to chemicals. For older kids, use broad spectrum sunscreen (one that’s effective against both UVA and UVB rays). It should have a rating of at least 15 SPF. Reapply every few hours. Don’t let teens use tanning beds. People who begin using them before the age of 30 have a 75 percent increased risk of melanoma, according to the International Agency for Research on Cancer. If a child has a mole, alert your pediatrician right away, Pappo advised. Early identification and removal of melanoma improves survival odds and reduces the need for more invasive surgery. More information The American Academy of Pediatrics has more on sun safety.
30 June 2018
SATURDAY, June 30, 2018 (HealthDay News) — During the summer when people trade in their jackets and jeans for flip flops and bathing suits, more skin is exposed to the sun’s harmful UV rays. Dr. Katherine Gordon, assistant professor of dermatology at UT Southwestern Medical Center in Dallas, said summer is the perfect time for people to get in the habit of checking their skin for signs of cancer. “We recommend that everyone get in the habit of checking for signs of skin cancer at regular intervals year-round, though understandably people are more likely to be thinking about skin cancer in the hot summer months,” Gordon said in a medical center news release. “You’ll want to check your skin from head to toe, including areas like the scalp and between your toes, so it’s helpful to have a partner to help you,” she added. When performing a skin cancer self-exam, however, it’s important for people to be able to spot signs of trouble. Gordon advised people to check for the following: Moles that are changing, have irregular shapes or uneven edges. Moles that are multi-colored, such as brown, tan and black. Moles that are raised. Moles that are large, or have a diameter larger than the size of a pencil eraser. Scales, itchiness, tenderness or pain around a mole. A sore that does not heal or recurs. Brown or black streaks under a nail. Older people and those with light-colored skin are at greater risk for skin cancer, but anyone can develop the disease. Gordon noted that men are more likely to develop melanoma, which is the deadliest form of skin cancer. Black people are also more likely to develop skin cancer in places that usually don’t get much sun exposure, such as the palms of the hands and soles of the feet, inside the mouth and under the nails. “While the five-year survival rate for skin cancer that has metastasized is low, if melanoma is caught before it has spread to the lymph nodes, the survival rate is 99 percent,” Gordon said. “So I urge everyone to inspect their skin thoroughly this summer.” More information The American Cancer Society has more on skin cancer self-exams.