Melanoma – the most deadly form of skin cancer

Did you know that May is melanoma month and that the number of people diagnosed with melanoma — the deadliest of skin cancers — increases by about 4 percent each year with one person dying from this disease every hour?

At the current rate of increase, it is predicted that melanoma will affect 1 in 50 U.S. citizens by 2010. Unlike people diagnosed with other common cancers, including prostate and breast cancer, people with melanoma have roughly the same therapies available and chance for survival as they did 30 years ago.

"The incidence and death rates for most cancers have dropped dramatically over the years, while the opposite is true for melanoma, where we see more and more cases each year and higher death rates attributed to melanoma," said Gavin Robertson, associate professor of pharmacology, pathology and dermatology and director of the Penn State Melanoma Therapy Program at Penn State Milton S. Hershey Medical Center. "Clearly there is an urgent need for more research in order to develop better therapies."

Melanoma develops from cells in the skin called melanocytes. Melanocytes function to produce melanin, which protects you from the damaging effects of the sun’s UV rays. The melanocytes are the ones that become cancerous thereby causing melanoma. A single sunburn doubles your changes of developing melanoma, so it is important to prevent sunburns by applying sunscreen when outside.

The chance of getting melanoma increases as you get older, but people of any age can get this deadly skin cancer. In fact, melanoma is one of the most common cancers in young adults. Each year, more than 50,000 people in the U.S. learn that they have melanoma.

Melanoma is a serious and potentially deadly disease. If it is not detected and removed at its earliest states, it may grow deeper in the skin and start to move around your body forming new tumors. This spread is called metastasis. As these tumors accumulate and grow larger in your body, they will eventually kill you.

The good new is that if melanoma is found and treated in its early stages; it is close to 100 percent curable. However, once melanoma has spread to other parts of the body beyond the skin, it is difficult to treat. You can play an important role in finding melanoma early, when it is curable.

Everyone has moles that are normal and harmless but they can develop into melanoma. Therefore, it is important to recognise changes in a mole that can suggest a melanoma may be developing. Adults should check their skin every month. Learn what your moles, freckles or other birthmarks look like so that you can notice any new moles or changes in existing ones.

Make sure all areas of your body are examined in a well-lit room. Others can help examine moles in hard-to-see areas, such as your back or the back of your thighs. If you notice any changes, consult with your doctor or with a dermatologist, a doctor who specialises in skin problems, immediately.

The ABCDE rule is often used to help tell a normal mole from an abnormal one or a melanoma. ABCDE stands for the following:

Asymmetry: A line can no longer be drawn through the mole with each half looking like the other, but rather each half is dissimilar.

Border irregularity: The edges are no longer regular but have become irregular, ragged, blurred or notched.

Color: Mole is not longer a single color but has differing shades of tan, brown or black, and sometimes patches of red, blue or white.

Diameter: The mole becomes larger than 6 millimeters, which is the diameter of a pencil.

— Elevation: Any change in height of a mole.

In rare cases, a mole developing into a melanoma may not fit the ABCDE rule described above, so it is important to be aware of changes in your skin, such as a new mole, any abnormally looking areas of your skin or any sores that don’t heal, which can indicate possible melanoma.

Your primary care physician or dermatologist can diagnose a melanoma. Because melanoma can be so aggressive, however, minimising the time between diagnosis and treatment is critical. To treat melanoma, the Medical Center has an excellent integrated Skin Oncology Program led by Rogerio I. Neves. The program provides a single, one-stop multidisciplinary clinic for patients to significantly reduce the time between diagnosis and treatment. Every Thursday morning in the Plastic Surgery Clinic, specialists in clinical oncology, dermatology, surgical oncology, dermatopathology and radiation oncology work together to provide their collective expertise to better serve patients suffering from this disease.

Penn State also has the nationally recognised Melanoma Therapeutics Program, which has led to significant discoveries and is developing new therapies to treat this disease.

Program researchers recently discovered how moles turn into melanoma and have identified new drugs to treat metastatic disease. Shantu Amin has discovered an exciting new drug called ISC-4 that shuts down a protein called Akt3 that was identified by program scientists in 2004. The drug is derived from a naturally occurring agent found in green leafy vegetables, which was subsequently chemically modified to contain selenium.

"Melanoma patients often suffer from selenium deficiency," said Amin. "By putting selenium into this new drug derived from a naturally occurring product, we not only supply the patient with selenium, but also make the drug more effective at killing melanoma cells at lower doses."

While the current study is based on studies in animals, the hope is to rapidly move the drug from the research bench to the clinic. This process is predicted to take three to five years requiring U.S. Food and Drug Administration approval for ISC-4 as an Investigational New Drug.

Other discoveries made by program clinicians and scientists are currently being tested in the clinics. An example is an early phase I clinical trial targeting advanced-stage melanoma that opened in March 2007 at the Penn State Hershey Cancer Institute after obtaining FDA approval.

Melanoma remains a deadly disease, but as better therapies are developed treatments will improve. Eventually these more effective therapies will lead to a cure for metastatic melanoma.

(Source: Penn State: May 2008)