Skin cancer treatment: Research combined with a comprehensive approach

May 22, 2015 | by Samantha Bona

Skin cancer is the most common type of cancer in the United States today, and its incidence is on the rise. Forty to 50 percent of light-skinned Americans who live to age 65 will have skin cancer at least once in their lives.

skin cancer treatment Skin cancer treatment is improving, especially for melanoma (shown here). Clinical trials and ongoing research have fueled the advances.

Most of these skin cancers – about 3.5 million cases – are the basal cell and squamous cell types, which are highly treatable if caught early. “A lot of people get basal cell and squamous cell skin cancers, but not a lot of people die of them,” said City of Hope board-certified skin cancer surgeon Laleh Melstrom, M.D., of the lesions that typically appear on the face, the tops of the ears and the scalp.

Added City of Hope dermatologist and assistant professor Jae Jung, M.D., Ph.D.: “For most small, nonmelanoma skin cancers, surgical incision is curative 95 percent to 99 percent of the time."

In contrast, there are just 79,000 cases of melanoma diagnosed in the United States each year – and 10,000 deaths.

Despite its relative rarity compared to these other forms of skin cancer, melanoma makes up about 50 to 75 percent of all skin cancer deaths, according to Melstrom. “Melanoma has seen a lot of progress in the development of targeted therapies to treat for systemic disease, but early surgical intervention remains the most effective strategy for preventing metastatic disease and prolonging survival,” she said.

If doctors can catch it at Stage 1, “melanoma has a five-year-survival rate approaching 98 percent,” Melstrom said, adding that “the vast majority of melanomas are early stage and curable. Just 12 percent or so present late and have a mortality risk.”

But, with leading-edge research and skin cancer treatment, the City of Hope skin-cancer team is at the forefront of the attack on even later stages of this most-deadly form of skin cancer.{C}

Pushing the boundaries of skin cancer treatment

“In the last few years, melanoma has been the type of cancer that has really shown the most progress in terms of treatments,” Melstrom said. “It’s the one cancer in 2015 that is probably the most exciting in terms of survival.”

These new treatments that have emerged in the last five to seven years “target aspects of the immune system to stimulate its response to melanoma,” Melstrom explained, delaying recurrences and progression. “Before, we had nothing of comparable merit. And there are more forthcoming. We have agents targeting B-RAF mutations, agents targeting PD1 and agents targeting CTLA-4. They’re targeting aspects of the immune system to stimulate the immune system’s response to melanoma.”

skin cancer treatment for melanoma Melanoma is the deadliest form of skin cancer, but is highly treatable if caught early.

In addition, said Jung, “right now, we have two clinical trials open for oncolytic virus to treat melanoma. ... It’s a product that Amgen has developed – a virus that helps to kill cancer called T-VEC"

Melanoma researchers are also studying the potential of modified pox, parvo and coxsackie viruses as ways to treat melanoma, Jung said. A team of City of Hope researchers is focused on the pox virus; researchers overseas and elsewhere are exploring the other options.

Such groundbreaking viral-based therapy works both by using a modified virus to kill the tumor as well as by stimulating the body’s immune system to attack the tumor.

What makes City of Hope’s melanoma treatment different from that offered at other hospitals, Melstrom said, is that “research is front and center here. Really cutting-edge trials are offered here. Research is not an afterthought.”

“Disease-based teams” at City of Hope consisting of surgeons, dermatologists, radiation oncologists, pathologists and medical oncologists meet biweekly to discuss each new skin cancer patient, assessing available clinical trials and which patients might be candidates.

“It’s a multidisciplinary team to optimize the care of patients,” Melstrom said. “Every patient is an individual. It’s not a formula we follow. We meet and formulate a plan before any treatment begins.”

Another thing that makes the skin cancer team different at City of Hope, said Jung, is “that our individual people are all very good and willing to do things that are a little outside of the box for the benefit of patients. The attitude here is, ‘What can we do to make this work?’ It’s a little bit of a different attitude from what I’ve seen at other places, which might be like, ‘Sorry, you don’t fit the protocol of X, Y and Z.’”

A comprehensive approach to treatment

In addition to helping formulate a diagnosis and skin cancer treatment plan, City of Hope dermatologists such as Jung treat the cutaneous side effects of skin cancer treatment, which can be many.

“Dermatology is becoming more prominent in the field of oncology because people can have a lot of skin reactions from treatments,” Jung said.

For example, some of the new, highly targeted forms of chemotherapy used to treat melanoma can cause rashes or new cancers such as squamous cell carcinomas, or they can make patients photosensitive.  “The new targeted therapies are not the traditional therapies where you get an infusion and lose your hair," Jung said. "These are very specifically targeted to the tumor area.”

One of the most important aspects of skin-cancer treatment is the lifetime follow-up. Skin cancer patients at City of Hope must return on a regular basis to ensure there are no new lesions or recurrences.

“If I was a patient with melanoma and I had an opportunity to go to City of Hope or a local hospital, I would think, why not start at the most experienced place first so you have that relationship with your team?” Melstrom said. “The long-term follow-up is key. What if you have a recurrence? God willing that never happens, but if it does, you’ve already got your team in place and they can act quickly.”

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Learn more about skin cancer treatment and research at City of Hope.

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Learn more about becoming a patient or getting a second opinion by visiting our website or by calling800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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