21 May NYU Dermatologist Discusses Skin Cancer Diagnosis and Treatment
MedicalResearch.com Interview with:
Melissa A. Wilson, MD, PhD
Assistant professor of Medical Oncology
NYU Langone Perlmutter Cancer Center
MedicalResearch.com: What are the most common types of skin cancer?
Dr. Wilson: Basal cell carcinoma, squamous cell carcinoma and melanoma. With rare exception, all are related to sun exposure.
MedicalResearch.com: Are some types of skin cancer more serious than others?
Dr. Wilson: Melanoma is the most serious form of skin cancer, with the highest risk of developing into metastatic disease. Most basal cell and squamous cell carcinomas are superficial and not as invasive, so removal is the treatment. Rarely, these can cause invasive and metastatic disease, but this occurs infrequently. Melanoma is much more serious. Of course, the earlier melanoma is detected and the earlier stage that it is, is more predictive of a favorable outcome.
MedicalResearch.com: Who is most prone to skin cancer?
Dr. Wilson: Persons with excessive sun exposure, fair skin, light hair and blue eyes – although it can certainly occur in anyone.
MedicalResearch.com: Are there recognized risk factors? Age? Skin type? History of sunburns or sun bed use? Transplant medications, biologics or cancer drugs?
Dr. Wilson: Excessive sun exposure; increased number of sunburns at a younger age, especially are the age of puberty – skin is sensitive and undergoing may changes, which is thought to be especially sensitive to sun induced damage. Blistering sunburns. Patients on immunosuppressants due to transplant are more susceptible to developing squamous cell carcinoma (predominantly) as well as melanoma (associated with potential use of immunosuprressants as well). We are also concerned for melanoma exacerbation with use of TNF alpha blockers (like in Crohn’s disease, Rheumatoid arthritis) – we tell patients who have higher risk melanoma stage to try to avoid these medications.
MedicalResearch.com: What are the signs of skin cancer?
- New, changing or concerning lesion that doesn’t look right or changed in anyway.
- Bleeding and itching lesion.
- Increased size, growth, or shape, elevation and changing color.
MedicalResearch.com: What is meant by the ‘ugly duckling sign’?
Dr. Wilson: In someone who has a number of moles, if one mole looks different or uglier or “not right” compared to the others.
MedicalResearch.com: How does a primary care doctor or dermatologist screen a patient for skin cancer?
- Full body skin checks looking carefully at patient’s moles.
- Over time, looking to see if they have changed.
- Patients with increased number of moles can have whole body photography performed and each mole is compared to pictures with each visit to assess if there has been any growth or changes compared to previous baseline (helps to determine if a mole should be biopsied).
MedicalResearch.com: What types of treatments are available or best?
Dr. Wilson: We have new treatment options for melanoma since 2011. There have been eight drugs approved for the treatment of melanoma. Im
- Imunotherapy — anti CTLA4 antibody, ipilimumab, and anti PD1 antibodies – pembrolizumab and nivolumab. Used as single agent or combination treatment.
- Target therapies (only work in patients if they have a BRAF mutation….which is approximately 50% of patients) — BRAF inhibitors, vemurafenib and dabfrafenib, and
- MEK inhibitors, trametinib and cobimetinib, used as single agent or combination treatment.
- Oncolytic virus – TVEC.
We tend to use immunotherapy as front line treatment as it has the possibility to offer durable responses in patients.
If patients are very symptomatic from their disease, and they have a BRAF mutation, we may start treatment with BRAF targeted therapy upfront, in order to get a rapid response. However, we usually use this therapy as second line if patients fail immunotherapy.
MedicalResearch.com: What do you tell your patients about sun protection?
Dr. Wilson: After they have one melanoma, they are at higher risk for another melanoma. Most of the time, however, the damage has already been done. However I do counsel patients on safe sun practices.
First, I tell them to have them and their children use sunscreen as part of their daily routine – regardless of season. Children usually up doing whatever they did while growing up – out of habit. So daily sunscreen on exposed skin and repeat application. Reapplication of sunscreen, hats, sun protective clothing. Staying out of direct sun exposure 10-4 (using sun umbrellas, sun protective clothing, long sleeves, etc.)
MedicalResearch.com: Are there genetic tests for skin cancer/melanoma?
Dr. Wilson: Some melanomas can be associated with mutations in a patients inherited DNA and are associated with some other types of cancer. These include breast cancer, ovarian cancer, and pancreatic cancer.
If there is a family history of melanoma and one of these cancers, we routinely refer to a genetic counselor and consideration of testing for the BRCA2 and CDKN2A (p16) gene mutations.
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