Skin cancer is the most common type of cancer, with 5.4 million cases of nonmelanoma skin cancers in the US annually. Most of these, 8 out of 10, occur in basal cells, and a smaller fraction is found in squamous cells; both types of cells are found in the epidermis, the top layer of skin. Melanoma, skin cancer in the pigment-producing cells, impacts more than 200,000 people yearly. However, such cancers have very high recovery rates because their treatments harness the body’s immune system.
“For most patients, immunotherapy is a powerful tool, and we have clear evidence of good results,” Dr. Evan Hall, assistant professor of medicine at the University of Washington and medical-oncologist at Seattle Cancer Care Alliance, shares. “In some people, it clearly can work for years and years. We now have patients, eight or nine years after treatment for widespread metastatic melanoma throughout their body, that we can’t find any trace of cancer.”
Many patients find their cancer themselves when they notice hyperpigmented, asymmetrical skin lesions. Occasionally, dermatologists or primary care providers will spot them. The next step is getting the mole biopsied to identify if it’s cancerous or benign. If it is cancerous, patients return to their surgeons for a more extensive procedure.
“Even if the melanoma is completely excised, there’s a chance that it can come back within a radius around where it usually is,” Dr. Hall explains. “Surgeons take a couple of centimeter margin all the way around the tumor to remove additional tissue and reduce the chance of a recurrence near the original skin tumor.”
Skin cancer can metastasize to lymph nodes, lungs, liver, bones, and brain. If surgery is insufficient to remove cancer, medical oncologists are brought on board to administer therapies, particularly immunotherapy, which are drugs that activate the immune system. Oncologists can use aggressive drug combinations for patients with metastatic disease or milder choices for those seeking adjunct therapy.
“We pick the right size hammer for the nail, so we are trying to use the appropriate strength immunotherapy, “Dr. Hall said. “As we use more and more immunotherapies together, the side effect rate goes up significantly.”
An overactive immune system could non-specifically attack functioning parts of the body, irritating normal tissues and causing side effects that can be life-threatening. This is especially a challenge for patients with immunosuppressed systems due to autoimmune diseases such as HIV/AIDS or organ transplants. For such patients, Dr. Hall tries to get “as much mileage out with a safer drug.” Chemotherapies have not shown to be as effective as immunotherapies and are much more toxic, especially in the long run, but targeted therapies are a promising avenue.
“One area that’s quite interesting is the idea of injecting immune-boosting medicines right into the tumors themselves,” Dr. Hall shares.
An easy way of keeping your skin safe is by using sunscreen with at least 30 every day (yes, even when there is no sun) to block UV rays. Staying away from tanning beds is also a great way to keep your skin healthy. There are also great graphics that show what you should be looking for on your skin to find any signs of skin cancer early.