What Do You Know About Melanoma? - NewsChannel5.com | Nashville News, Weather & Sports

What Do You Know About Melanoma?

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NEW YORK, NY (Ivanhoe Newswire) - Skin cancers account for 80 percent of all new cancers diagnosed each year. That means 430,000 people will be told they have it in 2012. What you don't know about skin cancer could end up killing you.

First, answer some questions to determine how much you know about melanoma.

Where does skin cancer not occur: Between your toes, on your palms, under your fingernails, or on your lips? Answer: skin cancer can actually happen in all of these places.

Can simply staying in the shade can protect you from getting skin cancer? Answer: yes, shade alone can reduce your exposure to ultraviolet rays by 75 percent. But you should still use a sunscreen of at least SPF 30 at all times.

Detecting and diagnosing melanoma can be tricky. The only way is through a biopsy, but even then, dermatologist Jonathan Zippin, MD, PhD, Assistant Professor of Dermatology at the New York Presbyterian Hospital, Weill Cornell Medical Center, said it's not that easy.

"The problem is, this grey area, is a controversial area. A lot of people don't know how to define it," Dr. Zippin told Ivanhoe.

Once the mole is tested, pathologists agree on just 60 to 75 percent of the cases. That's why Dr. Zippin has created a new diagnostic test that helps eliminate this "grey" area.

"It's a test that looks for a certain protein in the melanoma or mole," Dr. Zippin said. The protein, called sac, is expressed in all cells.

"It's not a question of whether it's there or not, it's a question of where it is," he said.

When analyzing at test results, doctors look at the red and blue markers. The red in the cell is the sac protein. The blue is the cell nucleus. When the red is next to the blue, the test indicates that the mole is normal. If the red is on top of the blue, the mole is cancerous.

"If it's in this area it's bad, and if it's in this area it's good. It's much simpler and much more consistently interpreted," he said.

Doctor Zippin said his protein test is still in the research phase, but doctors can send their biopsies to Cornell and his team will run the test for them. Also, don't leave your mole health just to your doctor. Experts said you should check your moles each month.

RESEARCH SUMMARY

BACKGROUND: Melanoma is the fastest growing cancer in the U.S. Melanoma is caused by changes in cells called melanocytes, which produce a skin pigment called melanin. Melanin is responsible for skin and hair color. A scary fact about melanoma is that it can appear on normal skin or start as a mole. Some moles that have been there since birth can turn into melanoma.

MYTH VS. FACT:

Myth #1:
A diagnosis of melanoma means that I have months to live.

There are four stages of melanoma, five if you include a form known as melanoma in situ, which is the earliest form of the disease and affects only the top layer of skin. The depth of the original melanoma is critical to determining how it will be treated and how patients are likely to fare. Although more melanomas are being diagnosed, the largest portion are made up of Stage 1 melanomas.

Myth #2: There is no difference between SPF 30 and SPF 100 sunscreen.

Although the baseline protection from SPF 30 and SPF 100 is not vastly different, the higher number provides longer coverage. One way to think of SPF is by time. If it normally takes you 10 minutes in the sun to burn, an SPF 30 sunscreen protects you for 300 minutes. An SPF 100 should, in theory provide 1,000 minutes of coverage.

Myth #3: If it is a cloudy day, I do not need to wear sunscreen.

About 80 percent of ultraviolet radiation reaches the earth even through clouds. Use a moisturizer with sunscreen daily, especially for areas such as your face that have high exposure.

Myth #4: If I am low in vitamin D levels, I must get some sun exposure.

Although the skin is the most efficient site of vitamin D production, adequate amounts can be obtained from your diet and from supplements. Vitamin D helps you absorb calcium and build strong bones, so we frequently recommend supplements that include vitamin D and calcium. ( Source: The Brigham and Women's Hospital)

NEW TECHNOLOGY: The new test is based on the soluble adenylyl cyclase (sAC) expression pattern and provides objective results: Melanoma is present if sAC appears in the nucleus of cells from a skin biopsy; the lesion is benign if the nucleus is negative. Most diagnostic stains highlight a particular cell in the biopsy, and if the stain is more intense, the cell tends to be melanoma. However, the meaning of "intense" is somewhat subjective. Investigators say the sAC stain should be used together with other diagnostic tests, such as light microscopy and three other stains currently available. They add that the new stain has the potential for expanded use across all cancers. (Source: http://dermatologytimes.modernmedicine.com)

INTERVIEW

Jonathan Zippin MD PhD, Assistant Professor of Dermatology at New York Presbyterian Hospital - Weill Cornell Medical Center, talks about a new test for melanoma.

What is your job when it comes to melanoma?

Dr. Zippin: As a dermatologist, my job is to see patients and perform skin exams. During my exam, I determine if there is a particular mole that I am concerned about. If I see such a mole, I recommend to the patient that we biopsy it. A biopsy is a short surgical technique to remove of a piece of the mole and then we send that to a pathologist.

How many people do you see a day?

Dr. Zippin: I split my time between clinical medicine and research. I see patients three mornings a week and the rest of the time I am in a laboratory where I do research.

How many years have you been doing this?

Dr. Zippin: I have been practicing dermatology, both as a resident and as an attending for about 6 to 7 years now. I have been at Cornell for all of that time.

Are you seeing more melanoma today more than ever?

Dr. Zippin: The incidence of melanoma is increasing. There are predictions that it could be as high as 1 in 100 people and it is predicted to continue to increase. The increased incidence has been attributed to increased UV light exposure.

Can it affect anyone at any age?

Dr. Zippin: Yes. There are different types of melanoma, which affect patients differently depending on age. we are seeing melanoma in younger people, especially young women, more commonly than it used to be.

Why do you think it is?

Dr. Zippin: A lot of people attribute the increased incidence of melanoma in young women to the increased use of tanning.

What is one of the biggest misconceptions about skin cancer and melanoma?

Dr. Zippin: Probably the biggest misconception is that it can only occur where the sun is exposed to your skin. A lot of people think that melanoma is strictly a sun-induced skin cancer. It is not. Although sun does play a role and it does play an important role, you can get melanoma where the sun does not shine. It can occur on the bottom of the feet, the bottom of the hands. It can occur in the private area as well and that is why it is really important that patients are constantly surveying their skin on a monthly to every other month basis in addition to seeing a dermatologist once a year.

What are the riskiest places?

Dr. Zippin: Between the toes, bottom of the feet, or the nail because these areas are commonly missed. If there is any change in pigmentation of the nail, it can be commonly missed. If it is a woman who is painting their toes or their fingers they may not notice it. These are areas where melanoma can go unbiopsied or unexamined for a very long time. The key to melanoma is early diagnosis because if you find it early and you remove it completely, the cure rate is very high. If you miss it and it grows to a certain depth, then the survival rate goes down depending on how deep the tumor has grown into the skin.

How is it usually diagnosed?

Dr. Zippin: Primarily, it is either by the patient seeing something on the skin that is concerning to them or a patient walking into my office or another dermatologist's office and us seeing something on the skin that we are concerned about. A piece of that mole is removed, sent to the laboratory and the pathologist when looking under the microscope confirms whether the mole is a melanoma.

Can you tell immediately, usually by just seeing it?

Dr. Zippin: Well, that is a really good question. In fact, there are some in which you are very confident are melanoma immediately. Moles or other growths that are derived from the cell melanocyte exist on a huge spectrum. On one end you have benign moles and on the other end you have melanoma. In between is this gray area. The problem is, that this gray area is a controversial area. A lot of people do not know how to define it and there is a lot of disagreement among pathologists as to what severity to put on that particular type of lesion. Do we call it an early melanoma? Do we say that it is perfectly benign? That is controversial and very important for us to figure out because if it is an early melanoma, you want to remove it aggressively where as if it is just a regular mole that is never going to become a melanoma, this person does not need a surgery and we want to prevent unnecessary surgery. This is especially true on a young child where some of these moles can be on the face and if it is treated as a melanoma, this child could have a disfiguring surgery.

Is this hereditary?

Dr. Zippin: There is a hereditary susceptibility. There are certain genes that have been found that are actually related to pancreatic cancer where if that particular gene is mutated, you have an increased risk of getting melanoma. if you are the kind of person who is forming a lot of strange looking moles, you are the kind of person who needs to be surveyed constantly because, physicians tend to look for what we call the "ugly duckling sign" meaning that is when we are looking at someone's moles, we are looking for that one that just should not be there. That prompts us to have suspicion and then do the biopsy. In the subset of patients who have a lot of strange looking moles, it makes that surveying technique very difficult for both the patient and the physician. Everything mole looks like an ugly duckling. These patients require a lot of surveying to make sure they don't develop melanoma and a lot of photography to keep track of their moles. We do full body photography in order to follow those moles to make sure there are no changes whatsoever.

Where does your experimental diagnostic test come in?

Dr. Zippin: The test is performed by the pathologist. It is a test to look for the presence of a particular protein in the melanoma or mole. The research that we are doing is to look and see if this particular protein can be used to help us determine whether something is a melanoma or is benign. We are really focusing on that gray area. We want to take that gray area and we want to make it smaller. Push more of the stuff into either the melanoma category or the benign category and then also help to increase the consistency of diagnoses amongst pathologists. Currently, there is as much as a 60-75% agreement. That is pretty low. We would like to get that number higher. That enables there to be more agreement amongst pathologists all over the country and we are hoping that this test will become something that will enable that to occur.

Is it testing the amount of protein?

Dr. Zippin: It is actually not an amount issue. This is an important reason why I embarked on this set of research. We actually created this antibody. The antibody is the test. An antibody is a way of measuring the presence of a protein. What we did is we created this test and looked at this protein in cells and noticed that it went to different areas of a cell. It did it very reproducibly. I first made this observation back in 2003. when I began my clinical training, I was frustrated by the fact that a lot of tests that were available for pathologists to do diagnosis on cancer were dependent on 2 different facts; is the protein present or absent? This can work except sometimes the machine that stains the tissue does not work; sometimes the test does not work. This may prompt a pathologist to say "Oh, it is not there, it is okay." Or "I can not interpret this test"

How is your test better than current tests being used?

Dr. Zippin: The other way pathologists use standard melanoma tests is to assess a signal strength which they rank as levels of expression, such as 1+, 2+, 3+. Three plus being a strong signal and 1+ being a low signal. The problem with this method is that one person's 3+ is another person's 2+. There is no easy way to agree upon how much of a signal strength is consistent with melanoma or with benign. The benefit of this particular analysis is that we are looking at a protein called SAC and this protein is expressed in all cells. It is not a question of whether is expressed, but rather where it is expressed. To determine where a protein is, in a cell, is very easy for a pathologist because the cellular structure is right in front of them. Therefore, the test is very clear, simpler and much more consistently interpreted amongst pathologists.

If it is in a specific area then it is cancerous, and if it is not in a certain area, it is not cancerous?

Dr. Zippin: That is exactly how it works. It is that simple.

In each cell?

Dr. Zippin: We are looking at the cells that make up a melanoma or mole. Those are called melanocytes. We are looking in those cells and saying, okay, we know that these are your melanocytes. Then we say, is the protein in a good area or is it in a bad area. we are hoping pathologists use this test to help them understand melanoma and continue to investigate this test. Only with further investigation will it become a test that will give pathologists more confidence to say that a mole is a melanoma.

How many moles are misdiagnosed as melanomas?

Dr. Zippin: That is a great question, but I do not know the answer. The reason we do not know the answer is we do not do the experiment. What happens is that patients come to a doctor and if they have a mole that looks like it might be a melanoma it is biopsied. If the pathologist is not 100% sure that it is a melanoma, and they are not 100% sure it is benign or an okay mole, they call it an in between name called a "dysplastic nevi." There are other names that people use but no matter the term, it means is that it is a little strange looking. The pathologist does not want to say that it is perfectly fine, but that it is not overtly a melanoma either. But the question that the patient always has is, "Well, could it become a melanoma?" Because we do not know the answer, we do not leave it in. We do not want to do that experiment because we do not want to risk that happening, so we end up just removing it. That is a surgery and that has a cost associated with it both to the patients psychologically as well as healthcare costs, but we have no other way of approaching it because we do not want to risk it actually becoming a melanoma. The goal of this particular research effort as well as other tests for melanoma is to help us to determine, "is this going to become a melanoma?" "Does this mole have enough of a genetic or signaling component that is abnormal that we can say this is going to become a melanoma?" and "should we treat this as an early melanoma?"

Is it frustrating for you when people come in and they have let melanoma go too long and now they are stage III, stage IV?

Dr. Zippin: Frustrating would not be the right word. I would say, I feel bad. I am very sad for the patient, but I actually have been very proud of my patients. I am very proud of the people I see because they bring to my attention a lot of things that turn out to not be melanoma and I think that is great. They are surveying their skin. They are looking for that oddball and they are bringing it to my attention. When you have the situation where someone comes in and they neglected something or it was where they cannot visually see it, it is sad because patients do not want to be in that position. But, fortunately, there is a lot of good work being done on therapeutics for people with late stage melanoma. It is not perfect, but it is better than it used to be. The goal of any dermatologist is never to allow a patient to get to that point; but to capture it well before we need to put them on a systemic therapy.

Can you do this diagnostic test anywhere or is it just right here, right now?

Dr. Zippin: Right now, it is in research phase, so the way to answer that question would be, if a patient was interested in having their mole analyzed with this antibody, they could send or have their dermatologist send the samples here and our pathologists here are trained to use this particular test and could offer some insight back to the dermatologist who did the actual biopsy. Alternatively if a local pathologist or dermatologist wanted to start investigating this test, they can get the antibody and start conducting their own research effort on melanoma and moles in their hometown. It is freely available from CEP Biotech, Inc and they can start to do the same work that we have done here at Cornell. There are other centers across the country, which are starting to use it now, on the heels of the publication.

FOR MORE INFORMATION, PLEASE CONTACT:

Jonathan Zippin MD PhD
Assistant Professor of Dermatology
New York Presbyterian Hospital - Weill Cornell Medical Center
jhzippin@med.cornell.edu

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