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Combating Melanoma: Shifting Focus in Treatment Development

By Philip Jordache

Melanoma is a very common and extremely deadly form of skin cancer that often goes undetected in the early stages of its development. One tiny, harmless-looking mole on a person’s skin could give rise to a continuously dividing mass of cells that forms a tumor. Over time, this tumor can flush the life out of a person. According to the Skin Cancer Foundation, more new cases of skin cancer occur each year than breast, prostate, lung, and colon cancer combined, and melanoma in particular causes a death roughly every 54 minutes.[1] These daunting statistics undoubtedly point to a need for the development of new methods of combating melanoma. However, many existing methods of melanoma detection need modification to shift their focus to early detection in order to be as preventative as possible—such a change would give rise to more effective and efficient melanoma detection, and would likely decrease the cost of detection associated with more drawn-out techniques such as monitoring cancer progression.

Some cancer detection techniques in practice today are used not by doctors but by patients themselves. Vitaly Terushkin, BS and Allan C. Halpern, MD discuss patient self-examination for melanoma in their review “Melanoma Early Detection,” citing a statistic that skin self-examination (SSE) could potentially decrease melanoma mortalities by up to 63 percent.[2] However, they also stress the continued importance of physician involvement in detecting early melanoma, claiming that physicians generally detect thinner melanomas than patients are able to, and that physicians often detect cancerous lesions at earlier stages than patients themselves are. These observations, together with the authors’ noting the dearth of patients who perform skin self-examinations, highlight the need for clinical methods of detection that do not rely upon patients.

The predominant existing accurate method of detecting melanoma is a biopsy of the suspicious area on the skin—physician visual examinations often fail to catch melanoma in its early stages. However, such a procedure involves removal of the skin and can prove an uncomfortable experience for the patient, not to mention the fact that results can take anywhere from several days to over a week to process, and can cost hundreds of dollars. Such delay can prove costly, as melanoma, like many other forms of cancer, can progress quickly. While the early stages (including 0 and I) remain in localized regions on the skin and are relatively harmless, Stage II tumors grow larger in size and begin to divide at a faster rate.[3] Metastasis, the deadly spread of cancerous cells throughout the body, occurs by Stages III and IV. By the time the tumor progresses to this point, it is often too late to save the afflicted person. Biopsies and other current clinical methods of melanoma detection, as well as patient skin self-examination, thus fail to meet the mark for early detection necessary to substantially reduce the annual mortality rate from melanoma.

Some studies have developed techniques to more closely and precisely monitor the progression of the disease in the human body. In one such study, researchers working for the Melanoma Cooperative Group attempted to gauge the clinical significance of particular PCR-positive mRNA markers as indicators of circulating melanoma cells in the peripheral bloodstream.[4] Using cellular RNA from the peripheral bloodstreams of 235 patients experiencing metastatic or localized melanoma, the researchers performed RT-PCR to determine through gel electrophoresis and Southern blotting that all mRNA markers exhibited statistically significant correlation with disease stage. Specifically, patients positive for at least three of the four tested mRNA markers exhibited considerable correlation with the stage of melanoma from which they were suffering. These results demonstrated that antigens present in the bloodstream can function as prognostic factors for monitoring the development of melanoma in afflicted individuals, an important point in understanding how to treat patients. However, such solutions merely make it easier to track melanoma--even with their implementation, melanoma could still often be identified only in its later stages, at which point it is untreatable. Early detection thus promises to be the key behind reducing the disease’s annual death toll.

Mass-screening programs have also been considered and, to some extents, implemented in various communities around the world. These programs, discussed in a review in the Journal of the American Academy of Dermatology by Alan C. Geller et al, generally consist of executing whole-body exams to screen asymptomatic people.[5] However, the authors also underscore the heavy reliance of such programs on government funding, citing this dependence as the reason for the failure of expansion of a screening program in Australia to additional communities. Although they identified successfully implemented mass screening programs in countries such as Denmark and Switzerland, as well as the United States, they also noted that few programs have “used prescreening publicity to reach high-risk persons who have minimal dermatologic care.” Such programs, which already suffer from lack of funding in many countries, therefore often fail to reach those who need them most, and the faultiness in physician visual examinations compared to clinical procedures in catching melanoma early on highlight the need for refining techniques to focus on early detection.

Fortunately, new early detection techniques are also being developed. The Knowridge Science Report published an article covering a team of researchers at the Norwegian University of Science and Technology (NTNU) that has developed a collection of computational algorithms to enhance the melanoma detection process undertaken by doctors. In this process, a photograph of a mole is taken, following which it is processed by a program that detects the area of interest on the skin.[6] The program focuses particularly on skin texture at the site of the mole, and utilizes various benchmarks relating to physical properties in order to evaluate the mole, and through this processing arrives at an overall conclusion as to whether or not the mole is cancerous. The method has proven highly successful with an accuracy of approximately 97 per cent,[7] and the research team maintains that if applied in the future, although the date at which it will be ready for rollout is uncertain, the technique will enable patients to test themselves for melanoma.

The world needs new, cutting-edge methods of melanoma detection such as that developed at NTNU. As one of the most common and one of the most fatal forms of cancer, and thus a leading cause of death throughout the world, melanoma poses a significant and imminent threat to society. While it is certainly helpful to continue research into tracking melanoma progression through its stages, it may prove even more beneficial to focus efforts more on developing early detection techniques involving testing suspicious moles on the skin quickly and directly. Such a direction promises to have great potential in significantly reducing melanoma’s death toll in the coming years.

References:

1. Geller, Alan C., Susan M. Swetter, Katie Brooks, Marie-France Demierre, and Amy L. Yaroch. "Screening, Early Detection, and Trends for Melanoma: Current Status (2000-2006) and Future Directions." October 2007. Accessed February 26, 2017. http://www.sciencedirect.com/science/article/pii/S019096220701050X+.

2. "New Method for Detecting Melanoma." Knowridge Science Report. January 27, 2017. Accessed February 14, 2017. https://knowridge.com/2017/01/new-method-for-detecting-melanoma/.

3. Palmieri, Giuseppe, Maria Strazzullo, Paolo A. Ascierto, Sabrina M.R. Satriano, Antonio Daponte, and Giuseppe Castello. "Polymerase Chain Reaction-Based Detection of Circulating Melanoma Cells as an Effective Marker of Tumor Progression." Journal of Clinical Oncology 17, no. 1 (January 1999): 304. Accessed February 13, 2017. doi:10.1200/JCO.1999.17.1.304.

4. "Skin Cancer Foundation." Skin Cancer Facts & Statistics - SkinCancer.org. Accessed February 14, 2017. http://www.skincancer.org/skin-cancer-information/skin-cancer-facts.

5. "Skin Cancer Foundation." The Stages of Melanoma - SkinCancer.org. Accessed February 14, 2017. http://www.skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma.

6. Terushkin, Vitaly, and Allan C. Halpern. "Melanoma Early Detection." Accessed February 26, 2017. http://ac.els-cdn.com/S0889858809000379/1-s2.0-S0889858809000379-main.pdf?_tid=a578c684-fc6b-11e6-b0eb-00000aacb360&acdnat=1488145175_f2e54577ec1ef8dfbde2e2241565f480.

 

[1] "Skin Cancer Foundation," Skin Cancer Facts & Statistics - SkinCancer.org, accessed February 14, 2017, http://www.skincancer.org/skin-cancer-information/skin-cancer-facts.

[2] Vitaly Terushkin and Allan C. Halpern, "Melanoma Early Detection," Discovery of melanoma by nonphysicians, accessed February 26, 2017, http://ac.els-cdn.com/S0889858809000379/1-s2.0-S0889858809000379-main.pdf?_tid=a578c684-fc6b-11e6-b0eb-00000aacb360&acdnat=1488145175_f2e54577ec1ef8dfbde2e2241565f480.

[3] "Skin Cancer Foundation," The Stages of Melanoma - SkinCancer.org, accessed February 14, 2017, http://www.skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma.

[4] Giuseppe Palmieri et al., "Polymerase Chain Reaction-Based Detection of Circulating Melanoma Cells as an Effective Marker of Tumor Progression," Journal of Clinical Oncology 17, no. 1 (January 1999): 304, accessed February 13, 2017, doi:10.1200/JCO.1999.17.1.304.

[5] Alan C. Geller et al., "Screening, Early Detection, and Trends for Melanoma: Current Status (2000-2006) and Future Directions," October 2007, Early identification, screening, and early detection, accessed February 26, 2017, http://www.sciencedirect.com/science/article/pii/S019096220701050X+.

[6] "New Method for Detecting Melanoma," Knowridge Science Report, January 27, 2017, Stimulates sight, accessed February 14, 2017, https://knowridge.com/2017/01/new-method-for-detecting-melanoma/.

[7] "New Method for Detecting Melanoma," Knowridge Science Report, January 27, 2017,Future app?, accessed February 14, 2017, https://knowridge.com/2017/01/new-method-for-detecting-melanoma/.

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