Protect Yourself From Skin Cancer

Rachel Woods, RN, is a nurse with surgical dermatology at Penn Medicine. 

February is National Cancer Prevention month and it’s a great time to remind everyone about the simple guidelines that can prevent or decrease the risk of certain types of cancer.

Along with routine screening exams such as mammograms and colonoscopies, your healthcare provider may recommend checking your skin for any new or changing lesions, moles, or marks.

Skin cancer is the most common cancer in the United States. Each year, there are more new cases of skin cancer than lung, breast, prostate and colon cancer combined.

The good news is that skin cancer is the easiest to treat and cure if detected early. And, although most people know if they are at a higher risk for skin cancer, some may not.

There are three types of skin cancer:

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Here are some risk factors for skin cancer:

• Red or blond hair
• Fair skin
• A blistering sunburn early in life
• Prone to sunburn
• Any tanning bed use
• Spending a lot of time outdoors for work or recreation

Historically, skin cancer was most commonly diagnosed in older adults. More cases are now being seen in younger people and an alarming increase of melanoma in young women that is likely associated with tanning bad use.

How to look for skin cancer

It is never too early to start screening your skin. Take a few minutes to look at yourself in a full-length mirror and use a handheld to visualize areas hard to see. You should be familiar with the moles and freckles on your body. Take note of anything that is changing in size, shape, or color. Also watch for pink shiny or scaly lesions that may bleed easily and don’t heal.

Now that you know to give your skin a good look on a regular basis, it’s important to know sun protection. There are three things everyone needs to remember when it comes to precautions outdoors:

1. Seek shade.
2. Cover up.
3. Use sunscreen.

Shade is important particularly when the sun is at its strongest. Typically this is between the hours of 11am and 4 pm. If the sun is at its strongest, your shadow will be shorter than you.

Covering up with clothing is a good start, but all clothing is not created equal when it comes to sun protection.

Clothing with UPF (ultraviolet protection factor) is specifically designed to protect from both UVA and UVB rays yet is cool and comfortable. These garments are perfect for children and anyone who spends a lot of time outdoors. Be aware that the efficacy of these garments decreases over time as the garment is worn and washed.

You can add UPF to regular cotton clothing by adding a sun guard detergent to your wash (sunguardsunprotection.com). This adds an invisible shield to your cotton clothing that bumps a regular white cotton T-shirt to UPF 30 through 20 washes.

Also, keep your eyes safe. Look for sunglasses that block 100 percent of UV rays and wear them even if your contact lenses have UV protection. To further protect your eyes in addition to scalp, ears, and neck, wear hats with a wide brim.

Using sunscreen is not a new recommendation. However, the U.S. Food and Drug Administration (FDA) recently changed the rules about sunscreen labeling to help consumers understand what they are buying.

Sunscreen labels must be accurate and cannot claim to do things the product hasn’t been proven to do. Be wary of older products that claim to be “water or sweat proof,” offer “instant protection,” or “block” the sun’s harmful rays.

These are examples of unproven claims are no longer allowed on packaging.
When purchasing sunscreen, look for:

• Broad spectrum sunscreen (or the ingredient “avobenzone”), which means that it covers both UVA and UVB rays.
• No less than 30 SPF, as recommended by The American Academy of Dermatologists.
• Water-resistant products if you will be swimming or sweating.

How to apply sunscreen

1. Apply liberally to skin at least 15 minutes prior to sun exposure. If you are in a bathing suit “liberally” means enough to fill a shot glass.
2. Reapply at least every two hours or after you swim.
3. Don’t forget your lips! Use an SPF 30 lip balm to keep this sensitive skin protected.

Free skin cancer screening

Take advantage of Penn Dermatology’s annual free skin cancer screening clinic on Saturday, May 19. Call 215-662-2737 to make an appointment now.

Remember, sun safety is year-round. Sign up for a free skin cancer screening today.
Melanoma Skin Cancer – Get the Facts

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Patients Show Resilience in the Face of Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the last of a series of four blog posts.  

Bernie Parent addressed the Abramson Cancer Center's Focus On Melanoma Conference on the topic of resilience — overcoming fear with purpose. Judging by the warm reception given to former Flyer goalie, Parent's contributions to two Stanley Cup winning seasons in the mid 1970s have not been forgotten. 

But for me, the real meaning of resilience became clear listening to the patients who participated in the panel discussion that followed his talk.

As I listened to the four panelists, so varied in age and background, yet sharing a common diagnosis, I thought of the program that aired last year on SHOWTIME®, called "The Big C." It purported to be a brave, gutsy, straight-on look at what it means to face a diagnosis of stage IV melanoma.  The main character, a 40-ish school teacher in Minnesota, learns she has the disease and decides to change her life, But she accepts her fate based on a single chest X-ray from a single physician (who looks like he barely finished high school). She doesn't tell a soul, not her husband, her son or a best friend, nor does she seek treatment.  I watched it twice and it made me too angry to watch again.

The voices heard at the conference could not be more different than this TV creation.  These were people who were fighting their cancers. They had formed a tight partnership of trust and hope with their treatment teams and endured multiple painful and debilitating treatments.  Every one in their own way had found meaning in the struggle.  No one suggested that there was a simple formula for becoming and remaining resilient.  They spoke of grief, anger and denial, but also of love, determination and the strength they draw from what may seem like life's smaller joys: a card from a friend, playing catch with their son.  Regardless of the state of their disease, each was deeply grateful for a continued existence, and every one of them expressed profound appreciation for the support and love provided by their friends and family.
 
Alice, the youngest of the group, was only 29 when she was diagnosed five years ago, long after Parent's heroics on the ice. She attributed some of her resilience to a form of denial, to "refusing to believe in her own end" as she put it.  She summed up the feelings of the group, and of so many people who have traveled down the cancer pathway with these words.

"I learned that despite having cancer, life marches on.  Things are still happening around you, work, vacations, babies, weddings," Alice said.  "I learned to accept the reality of the disease as a part of my life, but not as something that defines me. I will give what is due, but I won't let it become who I am."

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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Delivering Personalized Medicine for Cancer

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the third in a series of four blog posts.  

One of the key concepts in medicine today is "personalized medicine."  What few people may realize is that the emerging ability to talk about individual profiles for specific cancers results entirely from the type of research being done by people like Jessie Villaneuva, PhD, and Robert Vonderheide, MD. Drs. Villaneuva and Vonderheide presented highlights of their research at the Abramson Cancer Center's Focus On Melanoma Conference.

In the last few years, it has become possible to begin identifying subsets of patients based on the molecular characteristics of their cancers, and tailor new treatments to match those specific profiles.

Identifying these molecular characteristics is critical in treating many cancers, and increasingly so in melanoma.  Mutations in the BRAF gene occur in approximately 50 percent of patients with advanced melanoma and provide a valuable target for new therapies.  These therapies, however, are only effective for those who have the BRAF mutation.  The same principle holds true for other less frequent mutations. 

Finding this target has major implications for both developing new drugs and for delivering treatment to patients with melanoma.  It means more drugs are needed to hit multiple targets and that new drugs are likely to be more potent and more specific.  They will work better and be less toxic but in smaller populations of patients.  It also makes it critical that patients be aware of the need to collect sufficient tumor tissue to allow for molecular profiling of their tumor so they can receive the therapies designed to work best for their type of cancer.  Tissue collection is vital both at the time of diagnosis and if and when metastatic disease occurs as cancers often change their genetic profiles as they grow and spread.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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Advancing Cancer Research

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the second in a series of four blog posts.

Cancer research has become increasingly complex.  It is almost impossible for even the most educated non-scientist to understand the incredibly intricate mechanisms that drive normal and abnormal cell growth, and the language used to describe these phenomena is essentially foreign to all but those trained in biology, chemistry and genetics.  But, as science becomes more difficult to understand, it is also becoming more important.  It wasn't all that long ago that basic and clinical research were considered two separate worlds. Today, the gap between the lab and the clinic is narrowing, and the path between them is a two-way street. 

The presentations of Jessie Villaneuva, PhD, and Robert Vonderheide, MD, at the Abramson Cancer Center's Focus On Melanoma Conference, made it clear just how important research is in advancing the treatment of melanoma, and cancer in general.

Dr. Villaneuva researches cancer at the Wistar Institute, an independent basic research institute located on the Penn campus.  For many years, Wistar has had a top melanoma research program and maintained a highly productive collaboration with the clinical researchers and oncology team at Penn Medicine. Wistar researchers have been among the leaders in identifying specific genetic mutations that regulate cell growth along complex pathways.  For melanoma, these "broken" genes include BRAF, PTEN and several other less frequent mutations.  As Dr. Villaneuva pointed out, understanding the precise mechanisms that turn cell growth on and off is leading to new therapies. 

Basic research at the Wistar Institute and other leading centers is also critical in tackling the problem of drug resistance.  The pattern is all too clear, and too predictable.  A new cancer-fighting agent is identified.  A substantial percentage of patients respond to the drug, sometimes dramatically. But at some point, the drug becomes ineffective.  The cancer starts to grow again as the malignant cells develop ways of eluding or circumventing the action of the anti-cancer agent. 

Dr. Villaneuva described the efforts under way to understand the molecular mechanisms that lead to drug resistance and develop the next level of combination therapies to anticipate and overcome this huge challenge to successful cancer therapy.

For decades, researchers have known that melanoma is in many ways influenced by the body's immune system.  Dr. Vonderheide characterized this as an ongoing struggle between "the immune system versus melanoma."  

Immunotherapeutic approaches to treating melanoma have been consistently intriguing, promising — and disappointing. Melanoma appears to be capable of "waiting out" the body's natural immune response.  But researchers keep returning to this area, and now with their remarkably increased understanding of the complexities of the immune system, their work is bearing rich new fruit.   Immunotherapeutic approaches are the heart and soul of the new agents that are emerging for melanoma treatment. 

According to Dr. Vonderheide, these new approaches can either accelerate or activate the body's natural immune responses against the abnormal cell growth of melanoma, or "hit the brakes," actually slowing down the immune response to allow more effective interventions with vaccines and other cellular therapies.  While the immunotherapy work is proceeding on multiple fronts, the most exciting results are in the area of monoclonal antibodies, including ipilimumab, and several other targeted therapies in early stages of clinical trials.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

Learn more about melanoma treatment at Penn Medicine.

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The Relentless Fight Against Melanoma

Christine Wilson, cancer survivor, shares her experiences from the Focus On Melanoma conference in the first in a series of four blog posts.

Dr. Lynn Schuchter

Relentless. That word was used a lot at the Eighth Annual Focus on Melanoma Conference sponsored by Penn's Abramson Cancer Center (ACC). It was the word Lynn Schuchter, MD, used to describe Lorraine Gordon's quest to educate patients and physicians about melanoma and its treatment. Lorraine received the ACC Advocacy Award at the conference. *

Relentless. It has also been used to describe melanoma, a disease that for many years has resisted all attempts to improve its treatment and outcomes: until now. The clear message that Dr. Schuchter and her colleagues delivered to the more than 300 conference attendees is that the explosion of new knowledge and new treatments for melanoma are "changing the landscape" for patients at every stage of the disease: especially for those patients with advanced or metastatic melanoma.

Oncologists are rightfully wary about expressing too much enthusiasm for emerging new therapies. They have seen too many promising clinical trials end in disappointment. Physicians know that progress, when it does occur, is frequently measured in added weeks or months of life, not cures.  They are keenly aware that even the most positive results are tempered by the reality that behind every curve lurks the problem of acquired drug resistance, the seemingly inevitable ability of cancer cells to outsmart the approaches used to stop their growth.  But this time, the excitement is real. The optimism is grounded in the growing body of evidence from clinical trials that employ new knowledge and new agents.

As Dr. Schuchter's timeline indicated, progress has been frustratingly slow and elusive, dating all the way back to the identification of the first melanoma patient in the United States in the late 1800s.  In fact, not a single new drug had been approved by the FDA for treating melanoma in more than 20 years.  If surgery failed to eliminate the melanoma, interferon and interleukin, the mainstays of therapy for metastatic disease, were both highly toxic and limited in their effectiveness.

That scenario has changed dramatically in the last five years with the introduction and approval of three new agents with demonstrated effectiveness in treating advanced and high-risk melanoma.  The future is even brighter with the prospect of several new drugs currently in the research pipeline, two of which have reported remarkably promising results from clinical trials in 2011 alone.

The Value of Cancer Education

Just 20, or even 10 years ago, it was very difficult to find information about melanoma or its treatment. Today, the problem is no longer getting information; it is getting good information, and even more so being able to interpret it.  The value of an event such as the Focus On Melanoma conference is having an enormous amount of cancer information and education all in one place. The Focus On conferences, sponsored by the Abramson Cancer Center at the University of Pennsylvania, allows patients and families to get informed and interact with nationally recognized leaders in the clinical oncology and research fields.

A conference like this illustrates the ongoing, irreducible need for patients and their health care teams to interact, to communicate, and to merge information with perspective.

For more information, view the Focus On Melanoma conference video and Melanoma Treatment: A Patient Video Guide, on the ACC website.

* Lorraine Gordon is the wife of Roger A. Gordon, who lost his battle with melanoma. An educational fund was created in his name at the Abramson Cancer Center. Money from the fund was used to create a melanoma awareness brochure and treatment video.

Learn more about melanoma treatment at Penn Medicine.

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