Debra’s Story: Why tanning is not worth it
More Americans are diagnosed with skin cancer annually than all other cancers combined, and one in five will develop skin cancer by the age of 70, according to the American Cancer Society.
Last year, about 8,000 Floridians were diagnosed with melanoma, the most deadly form of skin cancer. The Sunshine State had the second highest number of melanoma cases in the nation, after California.
What’s a Floridian to do? Fortunately, if you know what to look for, such as spotting atypical moles, you’ll get early warning signs of skin cancer, making treatment easier and more effective, health experts say. And South Florida’s hospitals and research institutions are well-prepared to treat patients with cutting-edge therapies and technologies.
Miami Cancer Institute, part of Baptist Health South Florida, opened its Multidisciplinary Skin Cancer Clinic this spring, and with it, the region’s first 3D whole-body photo-imaging system designed to improve the accuracy of diagnosing melanoma and other skin cancers.
The new technology, known as the Vectra, takes simultaneous photos of the body and then creates a 3D view of the surface of the skin. This allows the dermatologist to potentially evaluate every suspicious lesion on the skin.
“The Vectra is a huge deal. It has 92 cameras and it takes a few milliseconds to take a picture. It creates an avatar of the patient. It’s a really good tool for following a patient over time,” said Dr. Jill Waibel, a dermatologist with the Miami Cancer Institute.
The Vectra allows the doctor to zoom in on irregularities and compare it to past images. In some instances, the technology has helped . Waibel identify asymmetrical borders on lesions that were not visible with the naked eye, she said. “It gives you a better set of eyes.”
As of now, the cost of Vectra imaging ($580) is not covered by insurance but that could change in the future. Baptist’s Vectra is the only one in Florida and one of only 13 in the world.
Miami Cancer Institute’s Multidisciplinary Skin Cancer Clinic focuses on early detection and treatment of melanoma, as well as basal cell carcinoma, squamous cell carcinoma, Merkel Cell tumors and other rare tumors of the skin. The program’s team of experts includes dermatologists, surgical and medical oncologists, radiation oncologists and plastic and reconstructive surgeons.
“We all conference about the patient before they arrive and already know a lot about them. Then we see the patient together and make a plan for their care,” said Waibel.
Although melanoma can be deadly, more is being learned about the cancer every day, she said.
“We know there are genetic influences on melanoma. We know 100 percent that ultraviolet radiation causes changes in DNA that can lead to melanoma. We know that people with more than 50 moles have an increased risk of melanoma and people with a family history of melanoma can have an increased risk,” she said. “But definitely Floridians have an increased risk because of our weather and lifestyle.
“We are getting more sun than we think we do.”
To treat advanced melanoma, University of Miami’s Sylvester Comprehensive Cancer Center, a Melanoma Center of Excellence, has been using a non-invasive therapy fast-tracked by the FDA in 2015. When melanoma continues to grow after surgery or if the melanoma can’t be surgically removed because of the location, size or number of lesions, doctors can inject an oncolytic virus into the lesion. The therapy is called Imlygic and it is typically covered by insurance plans.
“What these injections do is a less invasive way to treat what we couldn’t possibly treat before,” said Dr. Mecker Moller, a surgical oncologist at UHealth’s Sylvester, which also uses a multi-disciplinary team approach to care. “It’s a virus that we are using as a little card to deliver medication where we need it to. It isn’t only attacking the cancer cell we injected, it’s attacking the cancer in other cells.”
Although it’s not the primary indication, it has shown to be effective in distant metastases in some cases, she said.
After the treatments, 30 percent of patients showed no evidence of the disease.
“I have a patient with 54 lesions and another with 34 and within six months of treatment, given every two weeks, they basically disappeared,” Moller said. “This is very exciting for us because this disease [in later stages] has a very dismal prognosis because melanoma has spread to multiple areas of the body.”
She said a higher number of patients have had partial responses, in that the lesions disappear enough for the team to remove the rest with surgery.
“It gives hope to patients. Now, we also have immunotherapy. We can combine immunotherapy with the localized injections. There are clinical trials available for other treatments and therapies,” she said.
Sylvester also uses a multi-disciplinary team approach in treating patients.
Noting that the 5-year survival rate for melanoma is about 95 percent or higher in stage 1, 85-90 percent in stage 2 and then plunges to about 40 percent for stage 3, Moller said early detection is key.
“We can cure most of the patients when it is caught early. Once it has metastasized, it becomes way harder to treat because melanoma is a wild animal,” Moller said. “More research is needed but we are making big strides in understanding the biological aspects of melanoma. Melanoma is different from other cancers. Chemotherapy doesn’t work well for melanoma like it does for other cancers.”
To be sure, cases of melanoma are increasing, she said, but so is hope.
“We are curing more people because we are getting to them earlier. We are diagnosing more, but also curing more melanoma. That is the silver lining.”
Both doctors emphasized the need for South Floridians to be diligent about protecting their skin and getting regular screenings.
“We are in Florida. We can’t avoid the sun, but we need to be sun smart,” said Moller. “Avoid peak hours and wear sun protective clothing. Enjoy the beach during the hours that are not as intense, and protect the little ones.”
Waibel recommends using zinc titanium physical sunblock because it doesn’t penetrate into your system — and it’s safer for the coral reefs too. And above all, if you see something unusual — like a mole changing in color or shape or one that bleeds, oozes, itches, appears scaly or becomes painful — see a dermatologist.
With melanoma, even waiting three to six months could be detrimental, Waibel said.
Skin cancer prevention tips
▪ Apply a broad-spectrum sunscreen with an SPF (sun protection factor) of at least 30 daily. Reapply at least every two hours when outside (you need an ounce to cover most of the body.)
▪ Wear protective clothing, including a wide-brimmed hat and sunglasses with total UV protection. Avoid over-exposure to the sun, especially between 10 a.m. and 4 p.m., if possible. And definitely avoid getting a sunburn.
▪ Do monthly self-examinations of your skin and see a physician once a year for a professional screening exam. You can use online resources from skincancer.org to help you recognize moles or growths on your skin that may be developing into skin cancer.
▪ Stay away from tanning salons. Just one indoor tanning session can raise the risk of melanoma by 20 percent.
Source: Baptist Health South Florida