Dr. Andy

Reflections on medicine and biology among other things

Wednesday, April 27, 2005

Melanoma

is increasingly a problem in kids.

This month's Journal of Clinical Investigation (JCI) has a good review of melanoma (free to all), most of which is pretty accesible to non-experts (the part on genetic lesions in melanoma was tough for me to follow). Amy Adams, the senior author was an intern I worked with when I was a 3rd year resident, before she went on to do derm.

I hadn't realized how much worse melanoma is getting:
Recognized as the most common fatal skin cancer, melanoma incidence has increased 15-fold in the past 40 years in the United States
The increased risk seems to be related to increased sun exposure. I would have thought if anything, sun exposure has decreased (more people working inside, kids playing outside less) but apparently people wear a lot less clothing now:
In the 1920s, women’s fashions became more revealing, and French fashion designer Coco Chanel, who developed a suntan when cruising from Paris to Cannes, is credited with initiating the modern sunbathing trend (10). As our social dress has moved from petticoat and parasol or topcoat and hat to tank top and sunglasses, the incidence of skin cancers, including melanoma, has increased significantly.
Unlike basal and squamous cell carcinomas (which develop from skin epithelial cells, not pigment producing melanocytes) in which cumulative skin exposure is most important, melanoma risk is increased with history of bad sunburns.

Unlike many other cancers, the only effective treatment for melanoma is excision, once it has spread there are no established therapies:
Numerous agents have been used in the treatment of late-stage melanoma, but to date no single agent has significantly changed survival rates.
The article does a good job reviewing various promising, but experimental modalities, but unfortunately neglects "cancer vaccines" where attempts are made to harness the bodies own immune system to fight the cancer, which, I think, have shown particular promise against this cancer

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