Unmasking Melanoma: New Tools and the Role of Early Detection

Written by Craig A. Kraffert, M.D., board-certified dermatologist, president of Amarte, and founder of dermstore.com and ReddingDerm

The last five years have seen breakthroughs in melanoma evaluation and treatment. At the same time, aestheticians (one of the first lines of defense against melanoma) have multiple, newly available internet tools to guide client melanoma surveillance. Treatment options for all three types of melanoma – surface, invasive, and metastatic (widespread) melanoma – have expanded. New diagnostic tools that predict the risk of melanoma metastasizing (spreading out) have become routine.
The three most significant five- year innovations in melanoma management are:

  • the increasing use of imiquimod topical immunotherapy for surface melanoma (melanoma in situ)
  • Castle Company’s ‘Decision Dx – Melanoma’ genetic test that determines metastasis risk
  • intravenous (I.V.) immunotherapy to treat (and sometimes cure) widely metastatic melanoma

There are two primary types of melanoma. One type, called melanoma in situ, is a surface variant that is not immediately dangerous. In prior years, these surface melanomas were all excised – often on the face – with unavoidable surgical scarring. Today, an increasing proportion of these surface melanomas is treated with imiquimod cream immunotherapy. Imiquimod cream stimulates the immune system to seek and destroy melanoma cancer cells and has revolutionized the available options for surface melanoma therapy. Treatment can be a bit tricky, but results are often excellent and scar-free cures are common.

Once melanoma moves from the surface into the dermis, it has the potential to spread via blood and lymph systems. Because of this, invasive melanoma must be excised at its original site for local control. Once the original tumor is removed, the question of whether the melanoma has spread is a concern. Spreading occurs when melanoma cells break off the original tumor and travel to other parts of the body growing new tumors that, then, spread again. Until recently, the ability to estimate risk of spread was limited. The Castle Test (Decision Dx - Melanoma) is a genetic test that screens 31 melanoma genes to give a clear indication of each unique melanoma tumor’s potential to spread. The Castle Test has rapidly become the gold standard for metastatic melanoma risk assessment and has allowed doctors to refine their approach to each melanoma patient.

Until recently, metastatic melanoma treatment options have been very limited. Chemotherapy is poorly tolerated and mostly ineffective. Surgery and radiation are also of limited benefit. Today, however, a new dawn of treatment has arrived for metastatic melanoma – immunotherapy. Metastatic melanoma grows by playing a hide and seek game, avoiding detection and removal by the normal immune system. Immunotherapy works by supercharging the immune system, empowering it to detect and destroy melanoma naturally. Immune system stimulation helps overcome the cat and mouse game melanoma often plays. Immunotherapy uses specially designed biologic medicines consisting of laboratory-designed and crafted human antibodies that help transform normal immune cells into an activated, cancer-killing cellular army. Metastatic melanoma victims who receive immunotherapy are living longer and some have been cured. President Jimmy Carter, for example, was reported to have terminal metastatic melanoma but received immunotherapy and now appears fully recovered.

Melanoma is usually detectable long before it becomes deadly, but patients often do not realize they have a spot that could be suspicious for melanoma. Aestheticians have a role to play as part of the first line of melanoma detection in clients. Expanding the aesthetician community knowledge of melanoma detection has the potential to save client lives. The ABCDE guideline for melanoma detection is easy to remember.

  • A stands for asymmetry – watch for one side of a mole looking markedly different from the other side
  • B stands for border – watch for irregular, blurred, or scalloped edges
  • C stands for color – watch for moles with colors of varying shades including blue, red, and black
  • D stands for diameter – watch for odd moles larger than six millimeters, about the diameter of a pencil eraser
  • E stands for evolution – watch for a mole changing over time faster or more oddly than other moles

The more of these factors that are present, the more suspicious the mole is likely to be. When a mole reaches a certain point on the ABCDE scale, a suggestion to the client that they seek dermatologic evaluation may be helpful.

To summarize, the past five years have seen great advances in melanoma care. Imiquimod cream immunotherapy for surface melanomas has expanded treatment options for many patients. Castle Company’s Decision Dx – Melanoma Test is able to predict the risk of melanoma spreading, allowing doctors to customize their approach to each patient’s unique melanoma situation. Intravenous immunotherapy for metastatic melanoma helps patients live longer and cures some patients – patients who, not so long ago, had no viable treatment options. Despite these breakthroughs, early detection remains the best defense against melanoma. Aestheticians are encouraged to become allies in this battle to prevent melanoma from taking away friends, relatives, and fellow citizens.

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