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Skin Cancer Awareness and Prevention Efforts in Focus at American Academy of Dermatology

This week, Real World Health Care continues our recognition of May’s Melanoma and Skin Cancer Awareness Month by highlighting the work of the American Academy of Dermatology. We spoke with the AAD’s new President, Henry W. Lim, MD, about the organization’s mission and some of the challenges and opportunities associated with preventing and treating melanoma and other skin diseases.

Real World Health Care: Please tell our readers about the overall mission of the American Academy of Dermatology.

Henry W. Lim, MD, American Academy of Dermatology

Henry Lim: The American Academy of Dermatology promotes leadership in dermatology and excellence in patient care through education, research and advocacy.

As the largest, most influential and representative dermatology group in the United States, and the largest such organization in the world, the AAD works to make sure its values reflect this mission. The AAD’s values include putting patients first, encouraging its members to adhere to an uncompromising code of clinical and ethical standards, fostering an interest in our members to pursue lifelong learning, encouraging collaboration and working within our communities and embracing diversity.

Public Education: Sun Safety

RWHC: How does the AAD’s mission address melanoma?

HL: It is estimated that 161,790 new cases of melanoma will be diagnosed in the U.S. in 2017.  That is a staggering number that could be reduced if people incorporated skin cancer detection and prevention behaviors into their lives.

The AAD works to increase public awareness of skin cancer and its risks through its SPOT Skin Cancer campaign, which is designed to create a world without skin cancer through public awareness, community outreach programs and services, and advocacy that promote the prevention, detection and care of skin cancer.

The first step toward a world without skin cancer is educating the public about prevention. The Academy has long communicated sun-safety messages to the public about the importance of skin cancer prevention and detection.

In addition, dermatologists have led the medical community in finding and treating skin cancer. For more than 30 years, dermatologists across the country have hosted 2.5 million free SPOTme® skin cancer screenings that have detected 28,822 suspected melanomas and 256,329 suspected skin cancer lesions.

To assist the public with learning more about skin cancer prevention and detection, the AAD offers a variety of free, online videos, downloadable handouts and skin self-exam resources, including a body mole map, as well directories to find a dermatologist and skin cancer screenings.

Melanoma & Skin Cancer Awareness

RWHC: What is the AAD doing in 2017 to recognize Skin Cancer Awareness Month?

HL: The AAD’s 2017 SPOT Skin Cancer campaign, Check Your Partner. Check Yourself, encourages the public to be aware of changes on their skin that could be signs of skin cancer. Research has shown that women are more likely to detect suspicious spots on others.  Men over the age of 50 have a higher risk of developing melanoma, than the general population, so the campaign encourages women – often the health care decision makers of a household – to check their partner’s skin regularly, check their own skin, and to visit the AAD’s SpotSkinCancer website to find a free SPOTme® screening in their area.

RWHC: Do you have additional initiatives you’d like to highlight?

HL: In addition to the activities for Skin Cancer Awareness Month in May and the SpotSkinCancer™ website, the AAD works with state dermatology societies and state legislatures to introduce and support laws and regulations that protect consumers and promote awareness about skin cancer prevention and the dangers of indoor tanning. As a result, 42 states have enacted tanning bed restrictions to potentially reduce the risk of melanoma and other forms of skin cancer.

The AAD’s Shade Structure Program awards shade structure grants to schools and non-profit organizations across the country in order to protect children and adolescents from the sun’s harmful rays.  Since its launch in 2000, the AAD’s Shade Structure Program has awarded 350 shade structure grants, which provide shade for more than 600,000 individuals each day.

The AAD also has a strategic social media presence on Facebook, Twitter, YouTube and Pinterest, designed to raise awareness about skin cancer detection and prevention.  Social media, including paid, promoted posts, reach our targeted audiences – the public, our members and the media – with links to AAD resources.  We encourage our followers to like, share and re-tweet our skin cancer awareness videos and tips.

Melanoma Research

RWHC: Does the AAD underwrite or otherwise support research into melanoma detection and/or treatment?

HL: While AAD is not a research funding organization, the AAD does provide annual awards for Young Investigators in Dermatology.  These awards recognize outstanding basic and clinical/translational research by young dermatology investigators and some of the projects are related to melanoma.

The purpose of the award is to acknowledge research contributions by individuals at the start of promising research careers that further the improvement of diagnosis and therapeutics in the practice and science of dermatology.

RWHC: What do you see as the biggest challenges facing researchers studying melanoma treatments and clinicians treating melanoma?

HL: The rapidly changing health care environment presents major challenges to researchers and clinicians in all aspects of dermatologic care, not just those studying and treating melanoma. 

A significant challenge is the inadequate funding for research, together with the pressure to increase clinical revenue generated by clinician researchers.  For many years, the American Academy of Dermatology Association (AADA) has been active in advocating increased research funding by NIH to dermatology research, including through our support of the 21st Century Cures Act.

The current health care system also presents barriers that impede patient access to the best possible care from a qualified physician.  To combat this, the AADA is working with all dermatology care providers and other physicians to confront these challenges.

In particular, the AAD recently launched a new specialty positioning campaign, SkinSerious, to raise awareness of the serious impact of skin disease. Our goal is also to improve access to dermatologists’ expertise and increase collaboration with our physician peers to ensure high-quality patient care. We know that when dermatologists work with other physicians as part of the health care team, everyone can benefit from improved patient outcomes and lowered health care costs.

Other concerns within the health care environment that the AADA is closely monitoring include the rise of big data and the growth of teledermatology.  We closely follow developments at the federal and state levels and, when appropriate, the AADA will take action on issues that can be influenced positively for dermatology and pursue opportunities to impact health care policy. 

Promising Melanoma Treatments

RWHC: What do you see as the most promising or breakthrough melanoma treatments on the horizon?

HL: This is an exciting era in melanoma research.  In-depth understanding of the molecular pathways of melanoma development has led to the availability of immune checkpoint inhibitors; combinations of these medications are being looked at in clinical trials.  Metabolic manipulation of the peri-tumoral environment to inhibit the growth of melanoma is being actively investigated.  Understanding of the genes responsible for melanoma resulted in the availability of gene expression profile (GEP) test that can be used to determine biologic behavior of melanoma.

Melanoma Prevention

RWHC: What are the biggest challenges facing the medical community in terms of increasing awareness of and adherence to melanoma prevention efforts among the general public?

HL: The challenges facing the medical community around melanoma prevention are two-fold.

One is the misconception that a tan is a sign of health.  Tanning is a protective physiologic response of our skin to damage caused by ultraviolet radiation.  There is no such thing as a healthy tan, yet people continue to seek the sun or use indoor tanning, thereby increasing their risk of skin cancer.  This is a particularly challenging message to get across to young women and men, who feel peer and societal pressure to be tan.

The AADA was instrumental, along with several other organizations, in having the FDA re-classify tanning lamps from the Class I to Class II medical device category, which requires more supervision and restriction in their purchase and use.  For the past several years, the AAD has released a new public service advertisement that focuses on the dangers of tanning, particularly targeting young women.  We know that melanoma is the second most common cancer in young women, and this may be due in part to their tanning habits.

The 2016/2017 public service advertisement is called “Arms,” and features two young women comparing their tans at various stages in their lives. The emotional ad concludes with the two friends clasping hands in the hospital as one of them reveals she has advanced stage melanoma.  This PSA, and our previous ones, have resonated strongly with young women, especially on social media, where they have liked and shared the video with their friends.

The second challenging misconception is that many people believe that sun exposure is the best source of vitamin D.

While our bodies need vitamin D to build and maintain strong, healthy bodies, the AAD does not recommend getting vitamin D from sun exposure or indoor tanning because of the increased risk of skin cancer.  In fact, it has been demonstrated that sun exposure that results in increased vitamin D levels is directly correlated with DNA damage.

Vitamin D from food and dietary supplements offers the same benefits — without the danger of skin cancer — as vitamin D obtained from UV light.  Vitamin D cannot be used by the body until it is processed by the liver and the kidneys. The usable form of vitamin D created by this process is the same, regardless of how it enters the body.

The AAD recommends dietary sources (foods naturally rich in vitamin D, fortified foods and beverages) and vitamin supplements as sources of vitamin D that are available year-round and can easily be incorporated into a healthy lifestyle. Good sources include fortified milk, cheeses and yogurt, fortified cereal, and oily fish like salmon and tuna. Research shows that vitamin D supplements are well tolerated, safe, and effective when taken as directed by a physician.

The fact is these myths are harmful because the consequences of this misinformation could be potentially fatal.

RWHC: What personally inspires you to build awareness of the importance of preventing melanoma?

HL: Having been in dermatology practice for 40 years, I see on a regular basis the devastating effects that melanoma has on patients and their family.  The risk of developing melanoma can be significantly decreased by sensible photoprotection, and avoidance of tanning beds.  The exciting new developments in the treatment and genetic profiling of melanoma reflect the value of investment in scientists and research projects, and I look forward to additional treatments in the future that will benefit patients.

A MESSAGE FROM OUR SPONSOR:

The HealthWell Foundation, sponsor of Real World Health Care, is proud to have supported the melanoma patient community in recent years with copayment and premium assistance. We have helped more than 2,230 melanoma patients afford their treatments since approving our first Melanoma grant in 2011 — thanks to the generous support of our corporate partners. Due to high patient volume, our melanoma fund is temporarily closed until we receive additional funding. We invite corporations and individuals to help us meet this demand by contributing to our Melanoma-Medicare Access Fund, so nobody goes without essential medications because they cannot afford them.

 

Categories: General, Melanoma

The Mechanics of Melanoma

May is Melanoma Awareness Month. This article originally appeared in the Biotech Primer WEEKLY. For more on the science behind the headlines, subscribe. 

Melanoma 101 

Emily Burke, BiotechPrimer.com

Melanoma accounts for less than one percent of skin cancer cases, yet accounts for the vast majority of skin cancer deaths (skincancer.org). If detected early enough, melanoma is almost always curable. If it is not detected early, it is likely to spread to other parts of the body, where it is more difficult to treat. It’s estimated that in 2017, there will be 87,110 new cases of melanoma in the U.S., and 9,730 melanoma-related deaths (Aim at Melanoma Foundation). Melanoma is one of the types of cancers most common in young adults, with 25 percent of new cases occurring in people under age 45. Its prevalence is growing – the number of new cases/year relative to the total population has doubled since 1973.

In this column, we’ll review the basics of melanoma, and discuss the latest new therapies recently approved and in development.

Melanoma’s Method

Melanoma is the uncontrolled growth of the pigment-producing cells known as melanocytes, which are located in the bottom layer of the skin’s top layer (the epidermis). Like other types of cancers, melanoma arises from gene mutations in these cells that impact cell growth and division. In the case of melanoma and other skin cancers, the DNA damage is usually caused by ultraviolet (UV) radiation, resulting in a tumor that initially grows in the skin, spreading along the epidermis. If the melanoma is detected at this stage, it can often be surgically removed. If the out of control cell growth is not caught in these early stages, it penetrates deeper layers of the skin, eventually coming into contact with lymph and blood vessels which enable it to spread to other parts of the body. When the melanoma reaches this stage, it is called metastatic melanoma.

Although anyone can get melanoma, fair-skinned people are at higher risk for all types of skin cancer, since increased skin pigmentation helps to block the damaging UV rays from penetrating and damaging skin cell DNA. However, darker-skinned people can and do get skin cancer, and thus should also be vigilant about sun protection.

Atypical moles have also been linked to an increased risk of melanoma. Moles are clusters of melanocytes, and there is a slightly increased risk of melanoma arising within these clusters. Of course, most moles are harmless and do not lead to melanoma. However, any sudden changes in the color, shape, or size of a mole should be evaluated by a doctor.

Genetic Factors: p53 & BRAF 

Although most cases of all types of skin cancer are traceable to excessive sun exposure, about 10% are likely due to genetic factors. The gene most commonly mutated in familial melanoma is p53. p53 is a “tumor suppressor,” which means that it detects DNA damage in cells, and triggers either DNA repair pathways or activates cell death if the DNA damage cannot be repaired. Another gene, known as the BRAF gene, regulates cell growth and is mutated in inherited forms of melanoma. About half of all genetically-based melanomas have the BRAF mutation.

Let’s take a closer look at BRAF. BRAF codes for a protein required for the transmission of a growth signal from a cell surface receptor to the cell nucleus (growth signal transduction). Growth signaling is initiated by a growth factor binding to its receptor. This binding transmits a signal through the membrane, causing the internal portion of the receptor to interact with and activate a protein inside of the cell. This activation is then transferred to the next protein in the pathway, and so on until the signal reaches the last protein in the pathway. When this protein is activated, it enters the nucleus, where it turns on specific genes that make proteins which initiate cell division. BRAF is one of the proteins in this pathway. In BRAF-associated melanoma, the mutated BRAF is always turned on even when no growth factor is present.

Small molecule drugs that inhibit overactive BRAF have been developed and approved for the treatment of late-stage melanoma.

Immunotherapies in the Fight 

A few different checkpoint inhibitor therapies have been approved to treat metastatic melanoma. These are drugs that enable killer T-cells – immune system cells that recognize and kill threats such as cancer cells – to become fully active against a tumor cell target. These drugs target inhibitory proteins on the surface of T-cells such us CTLA-4 and PD-1. These proteins act as “off switches” for killer T-cells. By inhibiting these off switches, the killer T-cells become fully activated, and able to target and kill melanoma cells.

A second type of immunotherapy that has been approved for melanoma is an oncolytic virus therapy. An oncolytic virus is a virus that infects and kills cancer cells. The cancer cells are killed through cell lysis – as the virus multiplies inside of the cells, it causes them to burst open. This in turn releases new infectious particles that can target remaining tumor cells. In addition to direct killing of cancer cells via lysis, the presence of an actively replicating virus helps to activate the patient’s immune response to target the area.

In the Pipeline 

A new type of immunotherapy drug is in Phase 3 clinical development. The drug is a small molecule inhibitor of the enzyme IDO1. IDO1 helps regulatory T-cells to develop and become activated. Regulatory T-cells suppress the immune response, and therefore help cancer cells to escape immune surveillance. Inhibiting IDO1 should suppress the development of regulatory T-cells, bolstering the immune response against melanoma.

Implications of microRNA 

Last year, researchers at Tel Aviv University published a report describing how melanoma metastasizes. Their work suggests that melanoma cells release tiny vesicles that contain microRNA, a type of regulatory RNA produced by all cells. These micro-RNA filled vesicles induce changes in the dermis – the layer of skin just below the epidermis where the melanoma begins. The dermis contains blood vessels, and thus a pathway for metastasis. The changes in the dermis induced by the small vesicles released from the melanoma cells makes the cancer cells able to access those blood vessels. The Tel Aviv team is identifying drug candidates that may interfere with this process, preventing the metastasis that makes melanoma so deadly.

The best strategy for melanoma remains prevention and proactive monitoring – limiting sun exposure and monitoring the skin for any unusual growths or changes in moles. Increased understanding of the molecular pathways that contribute to melanoma’s development and spread will provide physicians with additional tools to fight those cases of metastatic melanoma that inevitably will continue to arise.

Categories: General, Melanoma

New Real World Health Care Series: Melanoma Research and Treatment

“Have you heard from mom and dad recently?” My sister’s question caught me off-guard.  Without realizing it, I hadn’t actually heard from my parents in a while.  She had already asked my brother the same question and he reported not hearing from them lately either.  With no imminent trips back to Michigan from our respective homes in Colorado, Maryland, and North Carolina, all three of us started calling and emailing our parents with some urgency to make sure things were well.

Krista Zodet, President, HealthWell Foundation

My mom’s email came back quickly, bringing us up to speed: “Dad went to the dermatologist about a troublesome spot on his cheek and the doctor did a full body check too.  He found a spot on the back of his thigh and did a biopsy.  Diagnosis: melanoma.  Treatment: surgery.” They removed a patch of skin from my dad’s leg – an area he couldn’t see and for the most part was covered by shorts or pants year-round.  It had been malignant and they got all of it.

That was early 2001, and my dad had just retired (talk about timing).  Because of early detection and annual check-ups since, he has been melanoma-free for 16 years.  We learned a lot about melanoma back then: It is the most dangerous form of skin cancer; and we also understand – thankfully – if it is recognized and treated early, it is almost always curable.

May is Melanoma Awareness Month

Since HealthWell opened its melanoma fund, I have learned even more about this devastating disease: Without early detection, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. According to the Skin Cancer Foundation, melanoma kills an estimated 10,130 people in the U.S. annually.

Treatment typically begins by surgically removing the melanoma. Surgical treatments have advanced over the past decade, and most can be done in the doctor’s office or as an outpatient procedure under local anesthesia. In recent years, Mohs Micrographic Surgery has become popular as an alternative to standard surgery for certain melanomas. This procedure spares as much of the normal tissue (known as the margins) as possible while allowing the surgeon to pinpoint the cancer’s location when it is invisible to the naked eye.

When melanoma cells spread to the lymph nodes (stage III) or more distant parts of the body (stage IV), the disease is considered advanced and additional therapy usually follows surgical removal of the original skin tumor. Thanks to an array of treatment options, patients with metastatic melanoma can extend their lives by months or years. A rising number of patients go into long-term remission.

The HealthWell Foundation, sponsor of Real World Health Care, is proud to have supported the melanoma patient community in recent years with copayment and premium assistance. We have helped more than 2,230 melanoma patients afford their treatments since approving our first Melanoma grant in 2011 — thanks to the generous support of our corporate partners. Due to high patient volume, our melanoma fund is temporarily closed until we receive additional funding. We invite corporations and individuals to help us meet this demand by contributing to our Melanoma-Medicare Access Fund, so nobody goes without essential medications because they cannot afford them.

 

 

Categories: General, Melanoma

UV Safety Month: Shedding Light on Melanoma Treatment and Prevention

In 2014, an approximate 77,000 Americans will be diagnosed with melanoma, culminating in nearly 10,000 deaths. Every eight minutes, an American is diagnosed with melanoma, and every hour, an American dies from it. Despite accounting for only four percent of all skin cancer cases, melanoma results in 80 percent of all skin cancer-related deaths. In observance of UV Safety Month, Real World Health Care is examining what’s working and what’s new in the prevention and treatment of melanoma.

photo (1)

Nathan Sheon

If detected early, melanoma is easily treated with surgery. If a tumor in the epidermis – the upper-most layer of skin – is removed before it deepens into the skin or spreads to other parts of the body, the likelihood of completely curing melanoma is high. When melanoma spreads, other treatment options include chemo- and radiation therapy.

Once melanoma has progressed to its later stages, however, treatment of the disease becomes much more difficult. For these patients, treatment options usually focus on extending life expectancy and improving quality of life.

Within the last few years, developments in melanoma research have provided promising leads on how to increase a patient’s lifespan beyond the capabilities of existing treatments. Certain activation immunotherapies – drugs that activate the immune system’s ability to fight disease – are showing potential in their ability to combat the spread of melanoma by killing tumors. Though these treatments do not work in all melanoma patients, in some cases they have been associated with unprecedented increases in lifespan.

“All of these trials involve late stage cancer patients. Suddenly we’re seeing those same patients getting two years or more survival time,” said Ashani Weeraratna of the Wistar Institute, the nation’s first independent institution devoted to medical research and training. “Enhancing the immune system such that it can effectively target and destroy your tumor has been a goal for many years. That’s [the field’s] big advance.”

Melanoma is almost always curable when detected and treated early on. Monthly self-examinations and yearly visits to the dermatologist are highly advised, even for those not predisposed to skin cancers. More information on how to perform a self-examination can be found online in guides from the Skin Cancer Foundation and the Melanoma Research Foundation.

Among other important measures like self-examinations and avoiding tanning booths, the American Academy of Dermatology (AAD) advises that wearing sunscreen when spending time outdoors is vital, especially during peak daylight hours between 10 AM to 2 PM. The AAD suggests using sunscreen with a sun protection factor (SPF) of 30 or above. With a range of sunscreen products on the market, choosing the right one can be difficult. Different products are more effective for different people depending on skin type. Visit the Skin Cancer Foundation’s guide for more information on choosing the right sunscreen product for you. For more information and tips on preventing and detecting melanoma, visit the AAD’s online guide.

How do you stay safe in the sun? Let us know in the comments section.

*Jamie Elizabeth Rosen, editor of Real World Health Care, contributed to this piece.

Will You Be There for Stella?

When patients are diagnosed with cancer, the last thing they should have to worry about is money. That’s why the HealthWell Foundation is planning to open the Emergency Cancer Relief Fund (ECRF). This Fund is something completely new and different – created specifically to help people with expenses not covered under HealthWell’s traditional copay fund structure.

Paul DeMiglio

Paul DeMiglio

For example, HealthWell will be able to grant as little as $25 to help someone pay for anti-nausea medicine and larger grants for things such as surgical expenses and diagnostic testing that piled up during their treatment. HealthWell has provided direct financial assistance so that more than 70,000 insured people living with cancer can afford their medical treatments.

Once open, ECRF will enable HealthWell to continue helping even more cancer patients just like Stella — wife, mother and caregiver from Baton Rouge, Louisiana, who was diagnosed with non-Hodgkin’s lymphoma. As Stella describes in her letter below, HealthWell’s grant was exactly what she needed to help her afford her treatments and continue caring for her family:

Dear Friends,

The past two years have been pretty bad for my husband and me. On February 21, 2011 we lost our only daughter to Scleroderma – a devastating disease that shrunk her skin, took her bones, her kidneys, her heart and finally her life – even though she had the best medical care available in Atlanta, GA.

We didn’t think things could ever be that bad again but, in July of that year, I was diagnosed with non-Hodgkin’s lymphoma – Type B. In August, our son (and only remaining child) was diagnosed with Stage IV prostate cancer. We feared that we would lose both our children in the same year; however, he was treated very aggressively with radiation and hormones and now is in remission.

My husband turned 90 this year and has bladder cancer, prostate cancer, he just had a melanoma removed from his face and two weeks later a squamous cell carcinoma was removed from his arm. The tests showed complete removal (how thankful we are for that). So far, we have been able to keep up with the copays for everything until non-Hodgkin’s lymphoma struck me. Without your generous support the winter of 2011 and June of 2012, I could not even have begun my treatment. But the Lord is good! He led me to a great medical team who led me to you kind folks and my treatment began in October 2011. I am now scheduled for four treatments, beginning in May and another four beginning in November, after which my doctor thinks I won’t need any more for a while.

Could you possibly help me with the series of treatments? I just have to get well. My husband is 90 years old and besides the cancer in various parts of his body, he is losing his eye sight, his memory (it is bad) and his hearing. There is no one else to take care of him. I am the last living of my family and he has one sis

ter who is in worse health than he is. Please! Let me know if you can help me in any amount. I will be eternally grateful. Please forgive the length of this letter. When I began writing, it just all poured out. I have no one to talk to about this, so thanks for listening.

Stella – Baton Rouge, LA

P.S. Please accept my meager check in the amount of $25.00. I hope there will be more available in time.

Money is the Last Thing A Cancer Patient Should Have to Worry About

Patients just like Stella who had nowhere else to turn are counting on HealthWell for financial relief right now. But for ECRF to open, we must raise $50,000 and have a long way to go before we hit our goal. So far we’ve raised $20,640 but aren’t there yet. Can we count of you to help us reach out goal?

Click here to learn about ECRF, and donate whatever you can — $5, $10, $25 — so we can make life easier for more patients who are struggling to survive.

Categories: Cost-Savings