Melanoma/Skin Cancer Awareness Month

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care
00:14 --> 00:15by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation
00:21 --> 00:23about Melanoma and other skin
00:23 --> 00:25cancers with doctor Christine Ko.
00:25 --> 00:27Doctor Ko is a professor of
00:27 --> 00:28dermatology and pathology at the
00:28 --> 00:29Yale School of Medicine.
00:30 --> 00:31Where Doctor Chagpar is a
00:31 --> 00:33professor of surgical oncology.
00:34 --> 00:36So Christine, maybe we can start off
00:36 --> 00:38by you telling us a little bit more
00:38 --> 00:40about yourself and what it is you do.
00:40 --> 00:43Yes, I'm a dermatologist and
00:43 --> 00:45dermatopathologist, so a lot of people
00:45 --> 00:47might understand what a dermatologist is.
00:47 --> 00:49But just in case, a dermatologist
00:49 --> 00:52is a physician who studies and
00:52 --> 00:55examines patients skin, hair, and nails.
00:55 --> 00:57Sort of the outer part of your
00:57 --> 01:00body and your scalp and your nails.
01:00 --> 01:02And a dermatopathologist is
01:02 --> 01:04someone who looks at tissue,
01:04 --> 01:06so the tissue from your
01:06 --> 01:08scalp, hair, nails,
01:08 --> 01:10under the microscope.
01:10 --> 01:12So if you've ever gone to a doctor and
01:12 --> 01:14had a piece of your skin taken off,
01:14 --> 01:16which is called a biopsy,
01:16 --> 01:17and had that sent to a laboratory,
01:17 --> 01:19and then you get a report back,
01:19 --> 01:21that report was created by a
01:21 --> 01:22dermatopathologist or sometimes
01:22 --> 01:24a pathologist without specialized
01:24 --> 01:25expertise in the skin.
01:25 --> 01:27But those are the two main things that I do.
01:28 --> 01:29So you do both.
01:29 --> 01:31You're a dermatologist and a
01:31 --> 01:33dermatopathologist, is that right?
01:33 --> 01:36That's fantastic.
01:36 --> 01:40So tell us a bit more about skin cancers.
01:40 --> 01:43I mean, it seems like you do skin
01:43 --> 01:46cancer all the time and we're now
01:46 --> 01:48celebrating Skin Cancer Awareness Month.
01:48 --> 01:51Talk a little bit about what that
01:51 --> 01:53landscape kind of looks like in terms
01:53 --> 01:55of how common are skin cancers.
01:55 --> 01:58What's the most common type
01:58 --> 02:01of skin cancer we see and how
02:01 --> 02:02is that diagnosed and treated?
02:03 --> 02:06Yes. So skin cancer is really important
02:06 --> 02:09because one in five Americans will have
02:09 --> 02:13a skin cancer by the time they're 70.
02:13 --> 02:17So that's 20%. And so in a nuclear family
02:17 --> 02:20that may typically be that one of those
02:21 --> 02:23people will have a skin cancer.
02:23 --> 02:25The most common type of skin
02:25 --> 02:27cancer is basal cell carcinoma.
02:27 --> 02:29And I know that's a lot of words.
02:29 --> 02:30It's 3 words.
02:30 --> 02:32But I abbreviate it to my patients and
02:32 --> 02:34we abbreviate it among doctors too.
02:34 --> 02:38We just call it B like boy, and 2 C's, BCC.
02:38 --> 02:40And so you can call it that
02:40 --> 02:42even as a patient, BCC.
02:42 --> 02:45And so that's BCC is the most
02:45 --> 02:47common skin cancer for Americans,
02:47 --> 02:49especially lighter or
02:49 --> 02:51fairer skinned Americans.
02:51 --> 02:54And that usually presents,
02:54 --> 02:56as we call it, pearly.
02:56 --> 02:59It might look a little shiny or
02:59 --> 03:02that kind of oyster like Translucence,
03:02 --> 03:04if you think of shellfish with
03:04 --> 03:07sort of blood vessels like red
03:07 --> 03:09little lines going through it.
03:09 --> 03:11And one thing that I often tell my patients
03:11 --> 03:14is that it can bleed relatively easily.
03:14 --> 03:15Like you're just sort of
03:15 --> 03:16washing your face or
03:16 --> 03:18it gets brushed with your clothing
03:18 --> 03:20or something and it
03:20 --> 03:22bleeds a tiny bit or sometimes a lot.
03:22 --> 03:24So that's the most common skin cancer.
03:24 --> 03:27The one cancer that of the
03:27 --> 03:29skin that a lot of people are
03:29 --> 03:31more familiar with is Melanoma.
03:31 --> 03:33And I think that's because of
03:33 --> 03:35really good skin cancer campaigns.
03:35 --> 03:37And people know that it's often a dark
03:37 --> 03:40spot and it might be changing or it
03:40 --> 03:42might be a little irregular in shape.
03:42 --> 03:44And that also I think people are aware
03:44 --> 03:47of because it can really affect
03:47 --> 03:48even younger individuals,
03:48 --> 03:51in their 20s and above.
03:51 --> 03:53So it can affect all ages and
03:53 --> 03:54it can be deadly.
03:54 --> 03:56So I think for good reason
03:56 --> 03:57there have been awareness campaigns
03:57 --> 03:59and people are becoming more and
03:59 --> 04:01more familiar with Melanoma.
04:01 --> 04:04And so let's talk a little bit
04:04 --> 04:06about each of those in turn,
04:06 --> 04:09maybe starting with Melanoma
04:09 --> 04:11since that's the most deadly.
04:11 --> 04:13Tell us a bit more about
04:13 --> 04:15what are the risk factors
04:15 --> 04:17for developing Melanoma,
04:17 --> 04:20is there a screening protocol
04:20 --> 04:22that people should follow,
04:22 --> 04:25who should follow it and so on?
04:26 --> 04:28Yes. So Melanoma is one of
04:28 --> 04:30the most deadly skin cancers.
04:30 --> 04:32There are others that are much more
04:32 --> 04:34rare like Merkel cell carcinoma,
04:34 --> 04:35so I won't talk about those.
04:35 --> 04:39But Melanoma skin cancer screening programs,
04:39 --> 04:43the general recommendation is for
04:43 --> 04:45each individual person to look at
04:45 --> 04:48your skin to do a self skin exam,
04:48 --> 04:50just like women and men are told
04:50 --> 04:53to do breast exams on themselves.
04:53 --> 04:56And so a skin exam actually I tell my patients,
04:56 --> 04:59is relatively easy once you get used to it.
04:59 --> 05:01And all you really have to do is
05:01 --> 05:03ideally have a full length mirror
05:03 --> 05:05but a waist up one
05:05 --> 05:07will do if that's all you have.
05:07 --> 05:10And when you come out of the shower or bath,
05:10 --> 05:11maybe choose the 1st of the month or
05:11 --> 05:13the last of the month or
05:13 --> 05:16the 15th or whatever day works for you.
05:16 --> 05:17And ideally, once a month,
05:17 --> 05:20just look at your skin, all of it,
05:20 --> 05:22including the genital area.
05:22 --> 05:23It's a little harder for women,
05:23 --> 05:25but we can take a mirror and look
05:25 --> 05:28at the genital area as well and
05:28 --> 05:31get used to what spots you really have.
05:31 --> 05:32Some people have very few,
05:32 --> 05:33Some people have a lot and just
05:33 --> 05:35get used to it and anything that
05:35 --> 05:37looks a little weird to you,
05:37 --> 05:38ask your doctor about it.
05:38 --> 05:40So that's a big component.
05:40 --> 05:41I think I advocate that
05:41 --> 05:43people do self skin exams.
05:43 --> 05:46The other thing you can do is you can
05:46 --> 05:49go to your doctor or your dermatologist
05:49 --> 05:51and have the physician do a skin
05:51 --> 05:54exam in which ideally they would look
05:54 --> 05:57at every single part of your body.
05:57 --> 05:59So I will examine under the hair,
05:59 --> 06:00you know, between the hairs.
06:00 --> 06:01If I can do it,
06:01 --> 06:03I will tell people to
06:03 --> 06:05enlist the hairdresser's help if
06:05 --> 06:07they go to a hairdresser or Barber.
06:07 --> 06:09For people that have a good
06:09 --> 06:10healthy amount of hair,
06:10 --> 06:11it can be hard to look in
06:11 --> 06:13between all of that hair,
06:13 --> 06:14and it's easier when it's wet.
06:14 --> 06:16So I'll ask people if they do go to
06:16 --> 06:18a Barber or hairdresser
06:18 --> 06:20if they ever notice anything,
06:20 --> 06:21ask them to take a photo,
06:21 --> 06:23kind of have a general sense of where it is,
06:23 --> 06:25and they can even upload that photo to me
06:26 --> 06:30in an electronic medical record.
06:30 --> 06:32And so then ideally the physician
06:32 --> 06:34will look under the hair,
06:34 --> 06:36in between the hair, the rest of the body,
06:36 --> 06:38the general nails,
06:38 --> 06:40bottoms of the feet,
06:40 --> 06:43so the socks and shoes come off as well.
06:46 --> 06:49Thank you for that really
06:49 --> 06:51thorough description because I think
06:51 --> 06:54that well many of us may have heard,
06:54 --> 06:57yeah, we should look at our skin.
06:57 --> 06:58We don't really think about
06:58 --> 07:00some of those other areas.
07:00 --> 07:02Taking a mirror and looking
07:02 --> 07:05at the genital area is something that
07:05 --> 07:07a lot of people may not think about,
07:07 --> 07:10especially because so much of us
07:10 --> 07:13think about skin cancers and Melanoma
07:13 --> 07:16as being related to sun exposure.
07:16 --> 07:19So in that area, if you haven't
07:19 --> 07:21gone skinny dipping for a while,
07:21 --> 07:24it generally isn't exposed to sunlight,
07:24 --> 07:26but is it still at risk for Melanoma?
07:26 --> 07:27Yes, absolutely.
07:27 --> 07:30I'm glad that you made that comment
07:30 --> 07:33because often my patients and
07:33 --> 07:35friends, family who talk to me
07:35 --> 07:37about skin and skin cancer and
07:37 --> 07:39how and when they should
07:39 --> 07:41be looking at their own skin,
07:41 --> 07:42they often say,
07:42 --> 07:44but I don't go to nude beaches
07:44 --> 07:47or I don't go skinny dipping.
07:47 --> 07:50And absolutely it's a myth and
07:50 --> 07:53that misconception comes from partial truth,
07:53 --> 07:56which is often the case.
07:56 --> 07:57Ultraviolet light,
07:57 --> 07:59sunlight, is a major contributor to
07:59 --> 08:02skin cancer and that's a major reason
08:02 --> 08:05why fairer skin or lighter skin,
08:05 --> 08:07especially skin types that
08:07 --> 08:09burn and virtually don't tan,
08:10 --> 08:12they burn and then they go
08:12 --> 08:13back to the fair skin that they
08:13 --> 08:15had before the burn and they
08:15 --> 08:17don't really become significantly
08:17 --> 08:19darker or tan in any way.
08:19 --> 08:21That's the highest risk skin type
08:21 --> 08:23for skin cancer because there's
08:23 --> 08:24essentially no melanin pigment.
08:24 --> 08:25Melanin is the
08:25 --> 08:28Pigment in the skin that
08:28 --> 08:30creates color that can create a tan and
08:30 --> 08:33with virtually no protection from melanin
08:33 --> 08:35you are at highest risk for skin
08:35 --> 08:38cancer compared to skin that's has
08:38 --> 08:40more melanin in it, but ultraviolet
08:40 --> 08:44light is not the
08:44 --> 08:47only risk factor and another risk
08:47 --> 08:50factor is for example human papilloma
08:50 --> 08:53virus and
08:53 --> 08:55I think that can make sense.
08:55 --> 08:57The way I often translate it to patients is
08:58 --> 08:59you know that cervical cancer or a
08:59 --> 09:02lot of people understand that and
09:02 --> 09:03they know about vaccination of
09:04 --> 09:06younger kids and even up to age 45
09:06 --> 09:08against HPV virus to prevent
09:08 --> 09:11cervical cancer as well as other
09:11 --> 09:13especially genital cancers and oral
09:13 --> 09:15cancers that are related to HPV virus.
09:15 --> 09:16But it's same for the skin.
09:16 --> 09:18And so that genital area or the
09:18 --> 09:20sort of near genital area,
09:20 --> 09:23a risk factor is human papilloma
09:23 --> 09:24virus.
09:24 --> 09:26And so that can be a reason why you
09:26 --> 09:28may have never gone to a nude beach,
09:28 --> 09:30but you can have skin cancer
09:30 --> 09:32in that area as well.
09:33 --> 09:36So does HPV vaccine protect you
09:36 --> 09:39against skin cancers in that area?
09:40 --> 09:41Yes, I think it can.
09:41 --> 09:45And so one thing for example is that
09:45 --> 09:47transplant patients who are
09:47 --> 09:48immunosuppressed because,
09:48 --> 09:50you know, to help them not
09:50 --> 09:52reject the transplanted organ,
09:52 --> 09:54they are at higher risk of skin cancer
09:54 --> 09:56as well as other cancers due to that
09:56 --> 09:58suppression of the immune system that's
09:58 --> 10:01appropriate to keep the
10:01 --> 10:03transplanted organ doing well.
10:03 --> 10:07But especially patients with sort of darker,
10:07 --> 10:08higher skin types,
10:08 --> 10:10they have higher risk of skin cancer
10:10 --> 10:12in those sort of more sun protected
10:12 --> 10:15areas and it is thought to be
10:15 --> 10:16because of human papilloma virus.
10:16 --> 10:19And there are efforts to see if
10:19 --> 10:21vaccination against HPV can reduce
10:21 --> 10:24skin cancers in that population.
10:24 --> 10:26So yes, you're absolutely right that
10:26 --> 10:29HPV induced skin cancers should be
10:29 --> 10:32prevented as well from the HPV vaccine.
10:33 --> 10:35Interesting. So you mentioned
10:35 --> 10:40that people with darker skin with
10:40 --> 10:43more melanin are more likely to
10:43 --> 10:48get these HPV type skin cancers.
10:48 --> 10:51Do we see other differences based
10:51 --> 10:56on race or or skin color in terms
10:56 --> 10:58of how skin cancers present?
10:59 --> 11:01Yes, that's a great question.
11:01 --> 11:04I'm not sure that they're more susceptible
11:04 --> 11:07to HPV induced cancers if they have
11:07 --> 11:09darker skin or you know higher type skin.
11:09 --> 11:13But just that since they have fewer
11:13 --> 11:16skin cancers in sun exposed areas,
11:16 --> 11:19that is an important
11:19 --> 11:21place to check for higher and
11:21 --> 11:23darker skin types including mine.
11:23 --> 11:27So but what I would say is,
11:27 --> 11:30that there are major differences
11:30 --> 11:33and so another major difference is
11:33 --> 11:36that higher or darker skin types and
11:36 --> 11:39I say higher because we kind of have a
11:39 --> 11:41Fitzpatrick skin color scale which kind
11:41 --> 11:45of gives you a number for the skin color,
11:45 --> 11:48the skin type that you have and
11:48 --> 11:51lightest or fairest is close to 0
11:51 --> 11:52Melanin and pigment.
11:52 --> 11:54That color that makes brown in the
11:54 --> 11:56skin or tan in the skin is A1.
11:56 --> 11:59And then the higher skin type is
11:59 --> 12:026 it goes up to six is darker skin,
12:02 --> 12:04the darkest that has the most melanin in it.
12:04 --> 12:06And it's also based on how your
12:06 --> 12:08skin reacts to sunlight.
12:08 --> 12:10So if you basically burn and hardly
12:10 --> 12:12really tan at all don't get darker,
12:12 --> 12:14you're a one.
12:14 --> 12:15And if you essentially never,
12:15 --> 12:16never ever burn,
12:16 --> 12:18but you do get a little darker from the
12:18 --> 12:20sun that's a six and in the middle 3-4,
12:20 --> 12:22it's like you generally tan
12:22 --> 12:23but you can burn.
12:23 --> 12:25And so that's the scale
12:25 --> 12:26that I'm talking about and why
12:26 --> 12:28I'll say higher skin types.
12:28 --> 12:31And so if you have higher skin types
12:31 --> 12:35we'll think like 4-5 and six,
12:35 --> 12:38you tend to get Melanoma for example
12:38 --> 12:40under your nails more so than if
12:40 --> 12:43you have lower skin types or on the
12:43 --> 12:45bottoms of the feet or on the palms
12:45 --> 12:47or you know for example in that
12:47 --> 12:49genital area as we talked about.
12:49 --> 12:52So I really emphasize to my patients
12:52 --> 12:54with higher skin types to definitely
12:54 --> 12:57definitely look in those areas as well.
12:57 --> 13:00And so I think that sort of myth
13:00 --> 13:03or misconception that it's sun
13:03 --> 13:05exposed areas may also contribute
13:05 --> 13:07to the statistics that we know
13:07 --> 13:09that are true that patients with
13:09 --> 13:11higher skin types often have their
13:11 --> 13:13skin cancers not often,
13:13 --> 13:16but maybe can have for sure their skin
13:16 --> 13:19cancers detected later than fair skin types.
13:19 --> 13:21And I think it might be because
13:21 --> 13:22of that myth or misconception that
13:22 --> 13:24people don't think you can have
13:24 --> 13:26a skin cancer under your nail or
13:26 --> 13:28on the bottom of your feet,
13:28 --> 13:29which generally isn't being
13:29 --> 13:30exposed to the sun either,
13:30 --> 13:33or the genital perigenital area.
13:33 --> 13:35Yeah, I was going to ask you that
13:35 --> 13:36question in terms of
13:36 --> 13:38the fact that we simply don't
13:38 --> 13:39think to check in those areas.
13:39 --> 13:41So that may contribute to
13:41 --> 13:43these being picked up later.
13:43 --> 13:46We are going to continue this very
13:46 --> 13:48interesting conversation right after we
13:48 --> 13:50take a short break for a medical minute.
13:50 --> 13:52Please stay tuned to learn more about
13:52 --> 13:54the care of patients with Melanoma
13:54 --> 13:56and other skin cancers in honor of
13:56 --> 13:58Melanoma and skin cancer awareness Month
13:58 --> 14:00with my guest Doctor Christine Ko.
14:01 --> 14:03Funding for Yale Cancer Answers
14:03 --> 14:05comes from Smilow Cancer Hospital,
14:05 --> 14:07where their Melanoma program
14:07 --> 14:09brings together an extensive
14:09 --> 14:10multidisciplinary team to diagnose,
14:10 --> 14:13treat, and care for patients with
14:13 --> 14:15Melanoma and other skin cancers.
14:15 --> 14:19Smilowcancerhospital.org.
14:19 --> 14:21It's estimated that over 240,000
14:21 --> 14:23men in the US will be diagnosed
14:23 --> 14:26with prostate cancer this year,
14:26 --> 14:28with over 3000 new cases being
14:28 --> 14:30identified here in Connecticut.
14:30 --> 14:32One in eight American men will
14:32 --> 14:33develop prostate cancer in
14:33 --> 14:35the course of his lifetime.
14:35 --> 14:37Major advances in the detection and
14:37 --> 14:39treatment of prostate cancer have
14:39 --> 14:40dramatically decreased the number
14:40 --> 14:42of men who die from the disease.
14:42 --> 14:44Screening can be performed quickly
14:44 --> 14:46and easily in a physician's
14:46 --> 14:48office using two simple tests,
14:48 --> 14:50a physical exam and a blood test.
14:50 --> 14:52Clinical trials are currently underway
14:52 --> 14:54at federally designated Comprehensive
14:54 --> 14:57Cancer centers such as Yale Cancer
14:57 --> 14:59Center and Smilow Cancer Hospital
14:59 --> 15:01where doctors are also using
15:01 --> 15:02the Artemis machine,
15:02 --> 15:04which enables targeted biopsies
15:04 --> 15:05to be performed.
15:05 --> 15:07More information is available
15:07 --> 15:09at yalecancercenter.org.
15:09 --> 15:13You're listening to Connecticut Public Radio.
15:13 --> 15:13Welcome
15:13 --> 15:15back to Yale Cancer Answers.
15:15 --> 15:17This is Doctor Anees Chagpar,
15:17 --> 15:19and I'm joined tonight by my guest,
15:19 --> 15:20Doctor Christine Ko.
15:20 --> 15:23We're talking about the care of patients with
15:23 --> 15:26Melanoma and other skin cancers in honor of
15:26 --> 15:29Melanoma and Skin Cancer Awareness Month.
15:29 --> 15:30Now, right before the break, Christine,
15:30 --> 15:34you were mentioning that some people,
15:34 --> 15:36particularly those who
15:36 --> 15:38have higher skin types,
15:38 --> 15:42that is to say darker skin with more melanin,
15:42 --> 15:44tend to get fewer skin cancers,
15:44 --> 15:48but may have proportionately more in
15:48 --> 15:51places that people often don't look.
15:51 --> 15:52So under the nails,
15:52 --> 15:54the bottom of the feet,
15:54 --> 15:55the genital areas.
15:55 --> 15:58Non skin exposed areas that
15:58 --> 16:00still can get skin cancers.
16:00 --> 16:03And so really important for people to
16:03 --> 16:06look because one of the very important
16:06 --> 16:08points that I think you made right
16:08 --> 16:11as we were going to break was that
16:11 --> 16:15these can be found at a later stage.
16:15 --> 16:17And so the question that
16:17 --> 16:20then leads into is
16:20 --> 16:22can you talk a little bit more
16:22 --> 16:24about the treatment algorithms
16:24 --> 16:25for treating Melanoma?
16:25 --> 16:28Stage is something that we'll use to
16:28 --> 16:31refer to how advanced a cancer is.
16:31 --> 16:35And really the goal of I think
16:35 --> 16:36physicians, dermatologists,
16:36 --> 16:39anyone who deals with cancer is to
16:39 --> 16:42detect it as early as possible and
16:42 --> 16:44so that you have early stage cancer,
16:44 --> 16:46people might be more
16:46 --> 16:47familiar with breast cancer.
16:47 --> 16:49But same thing applies to
16:49 --> 16:51Melanoma or other cancers.
16:51 --> 16:53And stage one cancer or even
16:53 --> 16:56to stage zero
16:56 --> 16:59is the best to have rather than
16:59 --> 17:01stage 4 which means that you have
17:01 --> 17:04cancer that has spread and so Melanoma
17:04 --> 17:07can definitely be stage 4, stage 3,
17:07 --> 17:09these higher stages that suggest that
17:09 --> 17:12you're going to have a worse prognosis
17:12 --> 17:14meaning that cancer really
17:14 --> 17:16might affect the course of your life.
17:16 --> 17:20And so ideally when we catch skin cancer
17:20 --> 17:22including Melanoma at stage zero,
17:22 --> 17:24stage 1 or even stage two,
17:24 --> 17:26we can cure the patient.
17:26 --> 17:30Usually the best way is just to cut it out.
17:30 --> 17:33And so it sort of
17:33 --> 17:35comes down to math, right?
17:35 --> 17:38If you imagine something smaller,
17:38 --> 17:40it's much easier to cut it
17:40 --> 17:41out no matter where it is,
17:41 --> 17:43even if it's in a sensitive area.
17:43 --> 17:47Like the genital area and the bigger it is,
17:47 --> 17:49the harder it is to cut
17:49 --> 17:50that larger thing out.
17:50 --> 17:52So excision or cutting something out
17:52 --> 17:55is the main way we treat things and
17:55 --> 17:58it works often very well and many,
17:58 --> 17:59many people have a cure.
17:59 --> 18:01And so I'll often tell people that,
18:01 --> 18:02for example BCC,
18:02 --> 18:04the basal cell carcinoma that
18:04 --> 18:05we mentioned in the first part,
18:05 --> 18:08that often is cured very easily,
18:08 --> 18:10relatively easily compared to other
18:10 --> 18:13skin cancers with a simple excision.
18:13 --> 18:14And people do very well.
18:14 --> 18:16And so it's the best cancer to
18:16 --> 18:18have is what I'll tell patients
18:18 --> 18:19if you have to have one.
18:19 --> 18:21Melanoma often can also be
18:21 --> 18:22cured with excision.
18:22 --> 18:24Other ways especially for
18:24 --> 18:27higher stages is
18:27 --> 18:28newer modalities,
18:28 --> 18:30there's been an explosion,
18:30 --> 18:32a really wonderful explosion in
18:32 --> 18:34cancer treatment for all cancers,
18:34 --> 18:36but also including Melanoma.
18:36 --> 18:38And we used to not have great
18:38 --> 18:41treatments for advanced stage Melanoma,
18:41 --> 18:43stage 3 or stage 4.
18:43 --> 18:45But increasingly we have new
18:45 --> 18:47treatments including something
18:47 --> 18:49called BRAF inhibitor treatment,
18:50 --> 18:51also MECH inhibitor treatment.
18:51 --> 18:53And they all have fancy names
18:55 --> 18:58but the important thing to remember
18:58 --> 19:01is that increasingly with help of
19:01 --> 19:03researchers and scientists and
19:03 --> 19:05physicians who dedicate their time
19:05 --> 19:08to research as well in laboratories
19:08 --> 19:11that there are molecular alterations,
19:11 --> 19:13there's alterations on that inside
19:13 --> 19:15cell level that are detected.
19:15 --> 19:17And so for Melanoma,
19:17 --> 19:19an example is a BRAF mutation,
19:19 --> 19:22BRAF is a particular gene
19:22 --> 19:24in our genetic code that can
19:24 --> 19:25be changed in skin cancer,
19:25 --> 19:28in Melanoma and a drug
19:28 --> 19:30targets that
19:30 --> 19:32particular BRAF mutation.
19:32 --> 19:34And so we have these advances
19:34 --> 19:36that can do wonders even with
19:36 --> 19:38stage 4 with metastatic Melanoma.
19:38 --> 19:41And so I would just say work
19:41 --> 19:43carefully and closely
19:43 --> 19:45with your oncologist and
19:45 --> 19:46you'll see that oftentimes there
19:46 --> 19:48can be really great treatments.
19:48 --> 19:50So you know, when you talk about these
19:50 --> 19:53fancy drugs that are
19:53 --> 19:56inhibitors of various mutations,
19:56 --> 19:58it certainly sounds a lot like
19:58 --> 20:00the precision medicine that
20:00 --> 20:03we've talked about on this show
20:03 --> 20:05previously for other cancers.
20:05 --> 20:07Can you tell us a little bit more
20:07 --> 20:10about how common these mutations are
20:10 --> 20:12in Melanoma because it's still the
20:12 --> 20:15perception of many that Melanoma is
20:15 --> 20:18the most deadly skin cancer.
20:18 --> 20:21But if the majority of these have
20:21 --> 20:26a targetable mutation and if those
20:26 --> 20:28drugs that are inhibitors of those
20:28 --> 20:31targetable mutations are very effective,
20:31 --> 20:33one can imagine that it might not
20:33 --> 20:35actually be as deadly as some think.
20:36 --> 20:38Absolutely. And that's why I said
20:38 --> 20:41there's this wonderful explosion of new
20:41 --> 20:44treatments because we are seeing that.
20:44 --> 20:46When I started out,
20:46 --> 20:48and even probably for a good half
20:48 --> 20:50of my career as a dermatologist,
20:50 --> 20:53if someone was diagnosed
20:53 --> 20:54with advanced Melanoma,
20:54 --> 20:57Stage 4 Melanoma that had spread,
20:57 --> 21:01that was pretty much a fatal diagnosis.
21:01 --> 21:04A really difficult conversation to have
21:04 --> 21:07with that patient about what was sort
21:07 --> 21:10of in store in terms of that cancer.
21:10 --> 21:11There were treatments,
21:11 --> 21:13say like interferon alpha.
21:13 --> 21:16But they didn't work that well and in
21:16 --> 21:19the vast majority of patients.
21:19 --> 21:21So now what we're seeing is
21:21 --> 21:23with that personalized medicine,
21:23 --> 21:24absolutely your cancer,
21:24 --> 21:27your Melanoma can be sequenced
21:27 --> 21:29and even just stained.
21:29 --> 21:32So now for that BRAF gene for example,
21:32 --> 21:34we have an immunohistochemical
21:34 --> 21:37stain which just means that your
21:37 --> 21:40pathologist or dramatopathologist can
21:40 --> 21:42stain the tissue with a particular
21:42 --> 21:45antibody and just see if the tissue
21:45 --> 21:47lights up a different color showing that
21:47 --> 21:50the antibody, that protein, is stained.
21:50 --> 21:52And so then that would suggest that
21:52 --> 21:54that personalized treatment with a
21:54 --> 21:57BRAF inhibitor would work versus if your
21:57 --> 21:59tissue doesn't stain,
21:59 --> 22:00it wouldn't work.
22:00 --> 22:03So we can get more and more precise and
22:03 --> 22:05personalized for the best treatment
22:05 --> 22:08to use on patients and so there are these
22:08 --> 22:10really stunning curves in science
22:10 --> 22:12journals that will show survival curves
22:12 --> 22:15and they're called waterfall plots.
22:15 --> 22:17It's kind of a pretty fancy
22:17 --> 22:18kind of picturesque term,
22:18 --> 22:21but it really shows that survival has really
22:21 --> 22:24changed with newer medicines like that.
22:24 --> 22:26And I just want to again emphasize though
22:26 --> 22:29that early detection is still better because
22:29 --> 22:32what happens with some of these medicines,
22:32 --> 22:33for example,
22:33 --> 22:35that BRAF inhibitor medicine
22:36 --> 22:38it's tricky and it's growing fast
22:39 --> 22:41because it's out of control, right?
22:41 --> 22:42That's what cancer is,
22:42 --> 22:44uncontrolled growth and it can bypass,
22:44 --> 22:48it can start to bypass around that treatment.
22:48 --> 22:50So the earlier we can detect it,
22:50 --> 22:52the fewer cells of cancer that there are,
22:52 --> 22:55there's less chance of that kind of
22:55 --> 22:57resistance to treatment developing.
23:03 --> 23:06Most melanomas have these mutations
23:06 --> 23:09such that they are targetable or
23:09 --> 23:12are many of them without a target
23:12 --> 23:15such that they need to be treated
23:15 --> 23:18with more generalized therapies like
23:18 --> 23:21chemotherapy or immunotherapy, yes.
23:21 --> 23:23So I would say the majority,
23:23 --> 23:26maybe 60% plus of melanomas can
23:26 --> 23:30have a targetable BRAF mutation.
23:33 --> 23:35Studies showed
23:35 --> 23:37relatively early on that treatment with
23:37 --> 23:40a BRAF inhibitor alone resistance
23:40 --> 23:42would often develop within sort of
23:42 --> 23:44less than a year's time in patients.
23:44 --> 23:48So now immunotherapy and
23:48 --> 23:51adding on other medicines on top of a
23:51 --> 23:54BRAF inhibitor is commonly used and
23:54 --> 23:57is very effective and can prevent
23:57 --> 23:59that kind of resistance from
23:59 --> 24:00forming, absolutely.
24:01 --> 24:04And so how many of these patients
24:04 --> 24:08who have a BRAF mutation who are
24:08 --> 24:12treated with targeted therapies then
24:12 --> 24:16relapse and I mean do we see
24:16 --> 24:18you mentioned that if they relapse,
24:18 --> 24:20they generally relapse within a year
24:20 --> 24:23but do many of them never relapse,
24:23 --> 24:26I mean is this truly curative treatment?
24:27 --> 24:30Yeah, there are definitely success
24:30 --> 24:32stories where there's a cure.
24:32 --> 24:35Some patients do need to stay
24:35 --> 24:37on that immunotherapy that inhibitor,
24:37 --> 24:40but it can keep
24:40 --> 24:43the cancer in check basically.
24:43 --> 24:45So yes, there are cures,
24:45 --> 24:47close to being cures or sort
24:47 --> 24:49of control of the disease,
24:49 --> 24:51yes and they're stunning.
24:51 --> 24:53Other patients may not have
24:53 --> 24:55as good a response rate and
24:55 --> 24:59I would say it is still to me
24:59 --> 25:01also part of personalized medicine
25:01 --> 25:02entails that your response
25:02 --> 25:05becomes what it is for you.
25:05 --> 25:07So there are statistics,
25:07 --> 25:09but good careful follow up and
25:09 --> 25:12follow up of any scans if you have them.
25:12 --> 25:14That kind of periodic monitoring
25:14 --> 25:17is probably at least right
25:17 --> 25:18now still always important.
25:19 --> 25:21And when you mention that some
25:21 --> 25:24patients need to take immunotherapy
25:24 --> 25:27to kind of keep this cancer under control
25:27 --> 25:30is that given orally and how long do
25:30 --> 25:33patients need to be on those therapies?
25:34 --> 25:35Yes, immunotherapy.
25:35 --> 25:37There are things like PD1 inhibitors
25:37 --> 25:41which are used for other cancers as well.
25:41 --> 25:43So people may be familiar with them
25:43 --> 25:46in other in the context of other
25:46 --> 25:48cancers like colon cancer or lung
25:48 --> 25:51cancer or other organ systems.
25:51 --> 25:53And they're generally infusions, yes.
25:53 --> 25:56So you would still go
25:59 --> 26:02get an IV put in and it would be
26:02 --> 26:04infused through your vein.
26:05 --> 26:08Getting back to where we started
26:08 --> 26:09this conversation, you know,
26:09 --> 26:12we talked to at the top of the show
26:12 --> 26:15about the spectrum of cancers and you
26:15 --> 26:18mentioned that the majority of cancers
26:18 --> 26:20are actually basal cell cancers.
26:20 --> 26:23And many of us may not talk a lot
26:23 --> 26:25about basal cell cancers because they
26:25 --> 26:28generally have a really good prognosis.
26:28 --> 26:29Is that right?
26:30 --> 26:33Yes. Basal cell cancer especially
26:33 --> 26:35when detected early, it's less
26:35 --> 26:37than you know say a centimeter,
26:37 --> 26:41it's highly curable with excision.
26:41 --> 26:43Then they don't require
26:43 --> 26:44any further treatment?
26:44 --> 26:48Generally not.
26:48 --> 26:51And so how can yoy
26:51 --> 26:53kind of guide our audience
26:53 --> 26:55when we're doing those very thorough
26:55 --> 26:57skin exams once a month that you had
26:57 --> 27:00mentioned in the first half of the show,
27:00 --> 27:02what should we be looking for in
27:02 --> 27:06terms of a basal cell versus a
27:06 --> 27:09squamous cell versus a Melanoma?
27:09 --> 27:10And when should we really be
27:10 --> 27:12going to our doctor and saying,
27:12 --> 27:14hey, look at this because,
27:14 --> 27:17many of us will have little spots,
27:17 --> 27:18moles, you know,
27:18 --> 27:20maybe a freckle or two.
27:20 --> 27:22And we really don't want to bother
27:22 --> 27:24our doctor if we don't think it's
27:24 --> 27:26anything to be concerned about.
27:26 --> 27:28But at the same time,
27:28 --> 27:30we want to be sure that we're detecting
27:30 --> 27:33anything that might be a cancer early.
27:33 --> 27:35So can you kind of give us some tips?
27:36 --> 27:38It's interesting because Melanoma,
27:38 --> 27:41which people are more aware, most aware of,
27:41 --> 27:43it seems like when I talk to my patients
27:43 --> 27:45it's great that they're aware of that,
27:45 --> 27:48but in the sense that Melanoma often
27:48 --> 27:52looks very different than other skin cancers,
27:52 --> 27:53especially BCC, basal cell carcinoma,
27:53 --> 27:55which is the most common as
27:55 --> 27:56we've been talking about.
27:56 --> 27:58And so basal cell carcinoma,
27:58 --> 28:02what you want to look for that
28:02 --> 28:04pink to sort of translucent
28:04 --> 28:06to sometimes dark,
28:06 --> 28:08it can sometimes be Gray or black,
28:08 --> 28:09especially in patients
28:09 --> 28:11with higher skin types.
28:11 --> 28:14That 4-5 or six Fitzpatrick scale,
28:14 --> 28:15it can be Gray.
28:15 --> 28:17So not everything that's dark
28:17 --> 28:18and irregular is Melanoma.
28:18 --> 28:22Sometimes it is BCC basal cell carcinoma.
28:22 --> 28:24So a general rule of thumb
28:24 --> 28:26that I'll tell patients is
28:26 --> 28:28let me know about, let your dermatologist
28:28 --> 28:30know your physician know about
28:30 --> 28:32anything that looks weird to you.
28:33 --> 28:35Doctor Christine Ko is a professor
28:35 --> 28:37of dermatology and pathology at
28:37 --> 28:39the Yale School of Medicine.
28:39 --> 28:41If you have questions, the address
28:41 --> 28:43is Cancer Answers at Yale dot Edu,
28:43 --> 28:46and past editions of the program
28:46 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Melanoma/Skin Cancer Awareness Month with guest Dr. Christine Ko May 14, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095