Reversing the course of melanoma

March 27—Deaths from melanoma, an aggressive form of skin cancer, have fallen sharply in recent years, according to new research co-authored by Alan Geller, senior lecturer on social and behavioral sciences, and published in the American Journal of Public Health.

Did the decline in melanoma-related deaths surprise you? What drove the decline?

For most other cancers, the mortality rate has been going down. But for melanoma, between 1986 and 2013, overall deaths from melanoma increased by a total of 7.5%. By contrast, between 2013 and 2016, overall mortality rates for melanoma declined sharply by 17.9% and this was even sharper for men over 50 who had the highest mortality rates. We were most surprised about how sharp the drop was and that it occurred among men and women and persons of all ages. This very sharp drop over such a short time is unprecedented in cancer medicine. It may be attributed in part to screening but it is more likely related to new drugs for the treatment of metastatic melanoma, first introduced in 2011, because the drop is so precipitous. The major types of treatment include immunotherapy and targeted therapy.

Does this research contain lessons that researchers and clinicians can apply to other types of cancer?

The fight to reduce the burden of cancer must be fought on all levels. We must learn how to prevent cancer, detect it early, and improve treatment. Tragically, even just 10 years ago, only 10% of patients with advanced stage melanoma would live more than 5 years. There is now evidence that a third of patients will live this long. More basic scientific research is needed to improve drugs for metastatic melanoma, but from a public health viewpoint, we have to make sure that all patients, regardless of income or insurance status, have equal access to drug treatment. In 2016, five years after the new drugs had been approved, only 37% of patients were being treated with immunotherapy.

What can be done to build on the momentum and improve access to the treatments you mention? What role can prevention play?

We have to build coalitions of patients, survivors, oncologists, anti-cancer organizations and the like to exert pressure on pharmaceutical companies and insurers to equalize access to treatment. No one with advanced stage melanoma whose doctor considers it safe for them to be treated should be denied access to therapy. But we do have to remember that early detection is most important. To that end, every American should be taught how to look at their skin for moles that could be problematic. Some of the signs to pay attention to are moles that have asymmetrical shape, a border that’s irregular, color that is getting darker, and a diameter greater than the size of a pencil eraser. People should also be on the lookout for moles that evolve in size or color over the course of a few weeks or months. Spotting melanoma early and asking your doctor to look at your skin are the lynchpins for further reducing the rate of advanced stage melanoma.

Chris Sweeney