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HEALTH&FITNESS
314
June14
Literally in the last five years, says surgical
oncologist DR DENNIS LIM, exciting
breakthroughs have been made in
melanoma research. Until very recently,
the diagnosis of a melanoma that had
metastasised – that is, gone beyond its
original skin location into other organs
of the body – was more-or-less a death
sentence. “Now,” he says, “we can look
forward to effective oral immunotherapy,
even for Stage IV patients.”
Setting the stage
“Nowadays, we have good treatment
available for patients at any stage of
melanoma,” says Dennis. “But because
these treatments are so different, it’s
crucial to identify accurately exactly what
stage the patient is at.”
In the
early stage
, the melanoma
has not spread beyond its primary site
and can simply be surgically removed.
To catch it in good time calls for regular
screening: first from a dermatologist,
and then ongoing surveillance to watch
for any telltale changes.
Individualised, personalised
and customised
As you’d expect, doctors generally work
according to the treatment guidelines
suggested by various authorities.
Governments, medical authorities and
insurers are very keenon theseguidelines,
saysDennis, but he firmly believes they are
not the be-all and end-all.
“As the patient,
you
don’t need
rigid guidelines,” he says. “You are an
individual.”
That’s why he both advocates and
follows a personalised approach that
takes into account the whole person,
including his or her stage of life. As a
result, two patients with the same degree
of advanced melanoma might receive
very different advice from him.
“If you were an 85-year-old stroke
victim with advanced melanoma, I
would surgically remove the primary
tumour, but suggest that we treat your
symptoms rather than go for the most
aggressive treatment. But for a 35-year-
old breadwinner in the prime of his or
her life, I would probably recommend
more aggressive treatment – even
beyond the guidelines for the stage of
their cancer – and be prepared to fight
a long and drawn out campaign in order
to give them the best possible chance
of long term survival.”
Outlook
About 50 percent of melanoma is
caused by a mutation in the BRAF gene.
“This mutation is what causes the cells
to grow uncontrollably,” Dennis explains,
“and we can test for this specific
mutation.” Once the mutation has been
identified, orally active drugs (in tablet
form) are available to target the BRAF
protein cells; this form of treatment is
known as
targeted therapy
.
“I am especially excited by the
immunotherapy
approach, though,”
Dennis says, “because it essentially
boosts your immunity against
any
cancer. What’s more, some of the new
orally active treatments are being found
to be effective against more than one
type of cancer, rather like the way aspirin
can treat a wide range of diseases and
conditions.” Utopia, he says, would be
a pill a day to control cancer.
MELANOMA …
• Is the most deadly of skin
cancers, but entirely treatable if
caught early enough
• Originates in skin cells called
melanocytes that produce
melanin, the substance that
gives skin its colour
• Can start in an existing mole or
in clear skin
• Is more readily identified on the
front of the body, where you can
see it; so you should get your
doctor, your partner or a friend
to check your back regularly, too
• Risk factors include family
history, fair complexion and
severe sunburns
“The
intermediate stage
is mainly
where my work and interest lie,” says
Dennis. “It is vital to establish whether
and how far the tumour cells have
spread along the lymphatic pathway. If
they have reached the lymph nodes in
the groin or the armpits, for example, it
is necessary to remove all those lymph
nodes to prevent further spread, but we
don’t want to perform this aggressive
treatment unless we need to.”
Sentinel node mapping was used for
melanoma as far back as the 1980s, he
tells me, long before it was widely used
in the treatment of breast cancer. “The
concept is that when a cancer ‘walks’ from
the skin to the lymph nodes, it always goes
through the sentinel lymph node; and the
sentinel lymph node predicts accurately
for the rest of the nodes: if it’s clear of
tumour, so are the others.”
The
metastatic stage
is where most
of the recent breakthroughs in drug
treatment have been made: “We’ve
gone from very physiologically impactful
intravenous chemotherapy, to orally
active medication that merely requires
you to take a tablet.”
One of themain thrusts is the use of our
own immune system to treat melanoma,
and many of the recent advances
come from here. New immunotherapy
treatments capitalise on this self-healing
tendency, by giving the body a helping
hand to eradicate cancer cells.
“The good news is that the body is
quite good at fighting melanoma itself:
in fact, we do see cases where a biopsy-
diagnosed tumour spontaneously
regresses,” says Dennis. This has
particularly been noted in association
with white patches on the skin called
vitiligo, which are more clearly seen in
darker skins – they are evidence the
work of the immune system having killed
off the cancerous melanocytes.
I t i s e v e n
thought that, in
time, melanoma
will, likeHIV-AIDS
and diabetes, be
treatable as a
chronic disease
– one that you
live with, rather
than die from.
Alexluengo | Maksim Shmeljov | Dreamstime.com