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Although it is one of the most aggressive cancers, we don’t have to die because of it. Melanoma is visible at a very early stage, when it can be cured – says prof. Piotr Rutkowski, head of the Department of Tumors of Soft Tissues, Bones and Melanomas at the Oncology Center at the Institute of Maria Skłodowskiej-Curie in Warsaw.
Halina Pilonis, Medonet: Although melanoma is an easy to spot cancer, mortality rates are very high. Every year 1100 people die from about 3000 new cases. Why?
Prof. Piotr Rutkowski, head of the Department of Tumors of Soft Tissues, Bones and Melanomas at the Oncology Center at the Institute of Maria Skłodowskiej-Curie in Warsaw: Unfortunately, in Poland 30 percent. patients begin therapy in an advanced stage of the disease. If melanoma had been diagnosed and treated early, the mortality rate from this cancer would have been much lower. However, in the late stages, the average survival time is only 6 months, with a one-year mortality rate of 75%, making melanoma one of the most aggressive cancers.
So what prevents us from starting diagnosis and treatment quickly?
The research carried out by TNS OBOP shows that every seventh Pole does not pay attention to the marks on his skin at all, and nearly half are convinced that they do not have any that should be monitored. Meanwhile, a threatening birthmark can appear on any skin at any time. If we want to give ourselves a chance, we should be more vigilant. You need to watch your body and know what birthmarks we already have. Then we can easily spot new ones. It is possible thanks to self-control.
More than half of skin cancers are detected in early fall, is this a coincidence?
Most melanomas and other skin cancers are associated with the damaging effects of ultraviolet radiation, i.e. sun and tanning beds. If we carelessly expose ourselves to overexposure to this radiation, we increase the risk of skin damage. Therefore, protection against ultraviolet radiation must not be forgotten. In many countries, thanks to the improved awareness of the risk of melanoma, it was possible to reduce the incidence of this cancer, incl. in Scandinavia or the USA. In our country, however, the disease growth curve is vertical. The incidence has doubled in recent years. Worse, it used to be an elderly cancer, but now the incidence is increasing in all age groups. It shouldn’t be that young people get melanoma, because it means that they had to work for it.
Our Baltic beaches are very crowded if the weather is good. Nobody is afraid of melanoma …
Fortunately, more and more people are already using sunscreen and sunglasses. Sunbathing is especially dangerous in childhood. Sunburn at the age of 4-5 doubles the risk of developing melanoma in adulthood. Children do not yet have a fully developed defense system of the body and are very easily burned. So, baseball caps, large-brimmed hats, sunscreen, body cover are absolutely essential.
However, I advise everyone not to spend the entire vacation on the beach. Walks, trips, cycling will not only distract us from all-day “frying” in the sun, but will also be a great prevention of obesity, diabetes and cardiovascular diseases.
Are Poles particularly vulnerable to melanoma?
Most Poles have a first or second skin phototype, i.e. one that is easily burned and tans poorly. This naturally promotes skin cancer, so Poles are at high risk of developing melanoma.
So if after the holidays we do an examination of conscience and come to the conclusion that we have sinned a bit by reckless sunbathing, what should we do?
You need to carefully examine your skin in all corners of the body, including the feet, groin, armpits, buttocks and intimate areas. It’s best to get help from someone else to get the back of your body checked. We pay attention to whether the skin has new changes and whether the old ones have started to change – enlarging, thickening or itching. Melanomas have many characteristics that help to recognize them. These features are determined using the ABCDE criteria (derived from the first letters of the English words: Asymmetry, Border, Color, Dimension and Evolution): A – asymmetry, e.g. a birthmark overflowing on one side, B – jagged, uneven, thickened edges, C – red or black and non-uniform color, D – large size, lesion size greater than 0,5 cm, E – evolution, i.e. progressive changes in the nevus. All moles, growths, and moles with these features should be examined by a dermatologist or oncologist surgeon and, if in any doubt, excised. The examination performed by a specialist is very quick, painless and non-invasive. The doctor scans the entire skin with a dermatoscope, which captures any unusual changes.
What if the lesion turns out to be melanoma?
Most changes are mild. If melanoma is diagnosed, but early, 95 percent. people will be fully cured. Most cases are treated surgically. If there are no metastases, surgery in nearly 90 percent. patients is effective. With the lesion thickness not exceeding 0,75 mm, the chances of survival are close to 6%. Unfortunately, in every fifth patient melanoma is so advanced that surgery cannot be performed. Until recently, the average survival time from diagnosis was 8-XNUMX months. Thanks to the emergence of new drugs, the survival time in these cases was significantly extended. Research on new drugs is ongoing. Hopefully they will lead to a completely curable melanoma or a chronic disease rather than a fatal disease.
What is the average survival time of patients treated with modern therapies? And what about the comfort of their lives?
For both pembrolizumab / nivolumab (anti-PD-1 immunotherapy) and combination therapy of BRAF and MEK inhibitor (molecularly targeted therapy in patients with metastatic melanomas with BRAF mutation), the median overall survival in clinical trials is approximately 2 years (i.e. about 4 times longer than 5 years ago). The patients’ quality of life is very high, better than previously used methods. Only about 5 percent of patients do not continue treatment due to side effects.
Can both molecular targeted therapy and immunotherapy be used in every patient? What influences the choice of treatment?
Each of these therapies has its limitations, e.g. immunotherapy does not work in patients with active brain metastases and in poor performance status. It cannot be used in all patients, e.g. with autoimmune diseases, and must also be performed in multidisciplinary oncological centers experienced in immunotherapy due to the potential side effects. In turn, molecularly targeted therapy can only be used in patients with melanomas with a specific mutation (BRAF, about half of the patients) and also requires experienced centers due to possible side effects.