Targeting Skin Cancer

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If you’ve ever spent time in a dermatologist’s office in Florida, then it may feel as if skin cancer removal is practically routine in the Sunshine State.

Florida is in the top 10 among all states for its number of melanoma cases, the deadliest form of skin cancer, according to a 2020 report in the International Journal of Cancer.

Although it only makes up 1% of all cancers in the U.S., it’s the fifth most common cancer for both men and women, the American Society of Clinical Oncology reports.

Melanoma has seen some treatment advances in recent years, says Catherine Degesys, a dermatologist at Mayo Clinic in Jacksonville.

For early-stage melanoma, surgery remains the primary treatment. Nowadays, there is less skin grafting needed, and surgery is nearly always as an outpatient versus inpatient, according to Christopher M. Pezzi, head of the division of surgery at Baptist MD Anderson Cancer Center in Jacksonville.

For more advanced or high-risk malignant melanoma, immunotherapy and targeted therapy are helping patients live longer. “Immunotherapy helps the patient’s own immune system fight their melanoma,” Degesys says. For melanoma, this includes a group of drugs called checkpoint inhibitors such as nivolumab (Obdivo) and pembrolizumab (Keytruda). Former U.S. President Jimmy Carter received immunotherapy for stage 4 melanoma that had spread to his brain and liver.

Targeted therapy is another option for melanoma as it focuses on mutations seen within the tumor for more directed cancer therapy, Degesys says.

Immunotherapy is routinely offered to stage 4 and stage 3 melanoma patients as well as some stage 2 patients. More than half of patients with stage 4 melanoma are alive five years after their diagnosis because of newer therapies, Pezzi says. “I did not know I would live long enough as a cancer surgeon to see patients being cured of stage 4 disease in these numbers,” he adds.

Ongoing studies are evaluating personalized cancer vaccines and cell therapies that use tumor-infiltrating cancer cells for melanoma treatment.

While fair-skinned, light-haired people are at higher risk, anyone can develop skin cancer. A type of melanoma that develops on the hands, feet and nails called acral lentiginous melanoma is the most common type of melanoma subtype in people of color and is associated with worse outcomes, Degesys says.

“We still see too many people with melanomas who, in retrospect, noticed the skin lesion months or even more than a year ago but didn’t do anything about it until it was more advanced,” Pezzi says.

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