The Changing Face of Skin Cancer

A tumor the size of an apple bulged from Emily’s left thigh. She wondered if the persistent pain in her leg meant her cancer was advancing. When her doctor confirmed her cancer had spread yet again, it confirmed what she already knew. She had Stage IV, metastatic melanoma — the deadliest form of skin cancer — and was told she only had six months to live.

Emily was first diagnosed at 20, after her mother noticed a black mole on her neck. She assumed the mole could simply be removed, but her dermatologist said the melanoma had spread and just “cutting it out” wasn’t an option.

I never thought skin cancer could be so serious. I just had a mole, and here I was, a 20 year-old with a death sentence.

After going through all the treatment options available for earlier stages of the disease, her melanoma still progressed. Ironically, Emily and her physician were optimistic about her Stage IV diagnosis because of the potential of entering a clinical trial for an investigational medicine.

Today, Emily considers herself lucky. “The medicine in the clinical trial has allowed me to live longer but I’ve learned not to take that for granted,” says Emily. “I never thought skin cancer could be so serious. I just had a mole, and there I was, a 20 year-old with a death sentence. Melanoma is scary and aggressive, so I’m always looking over my shoulder and still have scans every year to keep track of my disease.”

Uncovering the Real Dangers

Most cases of skin cancer can be cured, so a common misperception is that the disease is not serious. But skin cancer kills thousands of people every year. Over the past 10 years skin cancer has become increasingly prevalent, and more people have been diagnosed than with lung, breast or prostate cancer combined.1 In fact, more people develop skin cancer because of tanning than lung cancer because of smoking.2

Recognizing the need to raise awareness, the U.S. Surgeon General issued a “Call to Action to Prevent Skin Cancer” in 2014, naming skin cancer a major public health problem – among other health concerns like smoking and obesity.3 The Call to Action aims to reduce the number of cases through education because, although severe, skin cancer is also the most preventable cancer.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society and skin cancer survivor shared a personal perspective around the Call to Action, “Hopefully this report will bring that conversation to a new level and lead to more and better public health interventions. The reality is that in years past we didn't know what we could do to reduce the threat of skin cancer. We simply didn't know. Now we know.”4

There is also a great example to follow. Anti-smoking measures and public health interventions following the Surgeon General Call to Action on smoking in 1964 resulted in the reduction of lung cancer cases over the past 40 years.5 It still may take years for increased awareness about skin cancer to have an impact, but the Call to Action on skin cancer is a promising step in urging cooperative action to help reverse the upward trend in incidence and deaths by helping people understand the risks.

Burned by the Past

For 13 years Bob Scharf’s wife tried to convince him to see a doctor about several unusual lesions on his face. As a last ditch effort she set up a golf outing with a friend who was a dermatologist. One round of golf and an exam later, Bob was diagnosed with an advanced form of the most common type of skin cancer, basal cell carcinoma. At first, Bob felt guilty for not paying better attention to the lesions on his face. “I’ve lived on the beach my entire life and remember getting pretty bad sunburns in the past, but never thought I was at risk for skin cancer,” Bob says. “Everyone is at risk, especially if you’ve spent a lot of time in the sun.”

Bob (front row, left) and his family enjoying the beach in 1951.

His doctor said surgery was the only way to keep the cancer from spreading. After multiple surgeries to remove lesions from his face, Bob was about to lose his entire nose to the disease. Bob was eligible for a treatment that did not involve surgery or radiation. “I’ve been able to keep my nose thus far, but I’ve been through a lot and now for the first time in my life, I recognize the dangers of the sun.”

We're Making Progress

Thirty years ago, people with advanced skin cancer had limited treatment options. “When I was training as an oncologist about 15 years ago, we had few effective options to help advanced skin cancer patients,” said Josina Reddy, M.D., Ph.D., a group medical director at Genentech.

However, progress in treatment has rapidly accelerated in the past few years due to an improved understanding of how skin cancer cells multiply and grow. We now know that there might be more going on under the surface of an unusual mole or lesion. When skin cancer spreads to other parts of the skin or into the body, it is considered “advanced.” Advanced disease can be extremely aggressive, spreading to other organs; it can be disfiguring, potentially leading to the loss of an ear, eye, or nose. Unchecked, it may also prove fatal.

This understanding has led to the development of several new medicines in the past five years and an increasing number of clinical trials evaluating investigational medicines. For the first time in the history of skin cancer, medical advancements are being measured in months, not decades.

Josina as an oncology medical resident in 1997.

“This is an exciting time to be involved in skin cancer research,” Josina says. “We have been able to translate clinical research into more medicines, and we’re not only providing more options for people with advanced skin cancer, we’re also providing them with more hope.”

For Josina, the progress in treatments for skin cancer is enabling her to achieve a goal she set forth more than a dozen years ago — to combine her love of research and passion for patients like Emily and Bob and to bring medicines from lab bench to bedside. But the most exciting thing for Josina is the thought that someday skin cancer may become a rare occurrence.

“Skin cancer is a unique type of cancer to study because it’s the only one where we know the cause in more than 90 percent of cases6,”explains Josina. “I would love to look back and think of how we were able to stop studying a cancer because prevention, and effective treatments, led to eradicating the disease altogether.”