Hannah Kiefer thought she looked pretty with a tan—until she was diagnosed with melanoma, the deadliest form of skin cancer, at age 21. “I was addicted to tanning in high school and college, but I never thought I was at risk, because I have olive skin and don’t get sunburns,” says Kiefer, then a college junior.
Kiefer also thought she was much too young to worry about skin cancer. Actually, rates of melanoma have soared by eight-fold among young women over the past 40 years, and by four-fold among young men, a 2012 Mayo Clinic study found.
In fact, it’s now the leading form of cancer among young adults, ages 25 to 29, and the second most common cancer in teens, according to the American Academy of Dermatology (AAD), which has designated May 6th as Melanoma Monday, as part of an initiative to raise awareness of skin cancer risk.
The AAD asks Americans to support its SPOT Orange initiative by sharing photos of themselves, their friends, family or pets wearing orange on Melanoma Monday. The goal is to encourage early detection of melanoma and other skin cancer through self-exams.
Skin Cancer Linked to Higher Risk for Other CancersThis year, about 137,990 Americans will be diagnosed with melanoma and 9,480 will die from it—an average of one fatality per hour. By 2015, it’s expected to strike one in 50 Americans during their lifetime, while one in five will develop some form of skin cancer.
Melanoma survivors are at significantly higher risk for other cancers, particularly breast cancer, prostate cancer, and non-Hodgkin’s lymphoma, National Cancer Institute researchers reported recently.
In March, another study found that women with non-melanoma skin cancer (such as basal cell carcinoma) are at increased risk for melanoma, breast cancer, and lung cancer, even after other risks, such as smoking, were taken into account.
However, the good news is that skin cancer is highly preventable, because the #1 risk factor is exposure to UV light. A 2011 randomized study found that people who used sunscreen daily had only had half the rate of melanoma as those who applied it less often (or not at all).
Curable, If Caught EarlyIf melanoma is detected and treated early—as was the case with Kiefer—the cure rate is 98 percent, the AAD reports. However, if it spreads to nearby areas, survival drops to 65 percent—and to only 15 percent if distant organs are affected.
“I was very lucky,” says Kiefer, whose disease was treated with surgery that left 5-inch scars on her back. Now 28, she gets her skin checked every three months by her surgeon, Dr. Hooman Khorasani of Mount Sinai Hospital in NYC.
“I’ve had about 15 moles removed, some of which were precancerous,” adds Kiefer, who is also monitored with mole mapping in which digital photography is used to track changes that could be early signs of melanoma. It’s recommended for people at increased risk due to having more than 50 moles, new or changing moles, or a family or personal history of melanoma.
To help with early diagnosis, a new handheld optical scan for melanoma is now being used. Selected as one of the top 10 medical breakthroughs of 2013, the device uses imaging technology developed for non-invasive analysis of moles and suspicious skin areas. Light of ten different wavelengths penetrates the skin, then computer software compares the findings to 10,000 archived images of skin cancer. In a study of 1,300 patients, the device correctly identified 98 percent of melanomas, according to the Cleveland Clinic.
One of the Hardest Cancers to TreatWhen my father, Oscar Collier, was diagnosed with stage IV melanoma in 1997, he was treated with interleukin-2 (IL-2), which had such severe side effects that it had to be given in the ICU.
During this highly toxic treatment, my dad spiked fevers of up to 105 degrees and had hallucinations. A literary agent who inspired my writing career and love of books, Oscar died seven months later.
Although IL-2 only cures about 5 percent of patients with advanced melanoma, until recently doctors didn’t have much else to offer, says melanoma researcher Yvonne Saenger, MD, assistant professor of dermatology at Mount Sinai Hospital in NYC.
“There’s never been a study showing that chemotherapy improves survival of patients with metastatic melanoma, and in one study, 60 percent of patients’ tumors actually grew during chemo,” reports Dr. Saenger.
However, medical advances are now offering new hope to those with this tough-to-treat disease that accounts for 75 percent of skin cancer deaths, according to AAD.
Biggest Treatment Breakthroughs in 30 YearsTwo new drugs for metastatic melanoma were recently hailed as "the biggest breakthrough in 30 years," by significantly improving survival rates. In April, an experimental melanoma drug received the FDA’s new“breakthrough therapy” designation. The three drugs fight the disease in different ways:
- Yervoy (ipilimumab). This immunotherapy drug is an antibody that affects CTLA4, a compound believed to “act as the brakes on the immune system,” says Dr. Saenger. It’s been called “the first light at the end of melanoma’s dark tunnel,” the National Cancer Institute reports, but only works for about 20 percent of patients, cautions Dr. Saenger.
- Vemurafenib. About 60 percent of melanomas have a mutated gene called BRAF that plays role in their growth, reports Dr. Saenger. Sold under the brand name Zelboraf, this FDA-approved pill—the first targeted therapy for melanoma—nearly doubled survival of patients with advanced melanoma in a 2012 study.
- Lambrolizumab. Classified as a “breakthrough therapy” by the FDA in April, according to its manufacturer, this still experimental drug has shown promising results in a small clinical trial. It’s an antibody therapy that targets the “programmed death receptor.”
A “Promising”Melanoma VaccineDr. Saenger is getting “very promising results” in a stage 3 clinical trial Mount Sinai and other centers are conducting with an experimental melanoma vaccine called OncoVEX. It’s injected into tumors that can be felt or seen and acts like a smart bomb, selectively targeting cancer cells. It also boosts immune system response.
While the study results haven’t been published yet, one of the participants, Mary Ellen Lavin, 63, reports that OncoVex appears to have cured her stage III melanoma.
In 2009, she developed melanoma in her heel that spread to many areas of her leg as well as a lymph node. In 2010, after being treated surgically, Lavin entered the trial, which involved having each lesion injected with the vaccine every few weeks.
“It’s amazing—after a year, all of cancer went away,” says Lavin, who remains in remission after completing her treatment in 2011. “I’m incredibly thankful and grateful, because before I found this clinical trial, my prognosis was iffy. Now I have hope.”
In an earleir trial, 26 percent of the patients had a complete or partial response to OncoVEX, with only mild side effects. Dr. Saenger is planning a new study in which patients will be treated with OncoVEX and Yervoy, to see if combination therapy boosts response rate.
5 Warning Signs of Skin CancerSkin cancer is one of the few diseases you can detect yourself by checking your skin. You can download a free body mole map from the AAD to document your self-exam.
Know the ABCDEs of melanoma and consult a dermatologist promptly if you spot a mole or pigmented area with these characteristics:
- Asymmetry: One half doesn’t match the other.
- Border: An irregular, scalloped or poorly defined border.
- Color: Varies from one area to another, has shades of tan, brown, black, or less commonly, white, red or blue.
- Diameter: Melanomas are usually larger than a pencil eraser.
- Evolving: A mole or mark that looks different from the rest or is changing in size, shape or color.