PracticalDermatology

When, at age 91, former US President Jimmy Carter was pronounced ‘cancer free’ after a Stage IV metastatic melanoma diagnosis, many media outlets were quick to suggest that we may finally be winning the war on melanoma. Yes, there has been an influx of new targeted therapies aimed at metastatic melanoma in recent years, with even more in the pipeline, but are we there yet? An expert weighs in.

Mona Z. Mofid, MD, FAAD, is a dermatologist in San Diego and the Medical Director of American Melanoma Foundation.

Are we really winning the war against melanoma?

We have these great drugs to treat metastatic melanoma, and we are making amazing progress. For the first time, we have real hope, but these therapies treat the horse after it’s out of the barn.

Winning this war starts and ends with prevention and early detection. Nearly 90 percent of melanomas are considered preventable, and when we diagnose melanoma early and remove it surgically the cure rate approaches 100 percent.

What’s needed to beef up our melanoma prevention efforts?

Once we get to a place where getting a tan on the beach is not cool, we will win this war. Our societal perception of tanning is parallel to how people used to view smoking. Everyone did it. Smoking was the cool thing to do...until it wasn’t. We need this to happen with tanning. The number of skin cancer cases from tanning is higher than the number of lung cancer cases from smoking.

Legislators and public health officials tried to levy higher taxes on cigarettes and placed graphic warning labels on packs to curb smoking rates. These efforts helped us reach the tipping point, but they didn’t work on their own. Grass roots education that took the ‘cool factor’ away from smoking did the trick. It’s happening now with tanning too. Today we see high school kids and Girl Scouts doing projects on the dangers of tanning instead of getting tans. Today’s children wear rash guards and wide-rimmed hats on the beach and poolside to protect their skin from burns. In the past, these kids would have likely been ridiculed. Once we make it cool to protect your skin and uncool to get a burn, that’s when we turn the tables on melanoma.

Where are we in terms of “ban the tan” movement in the US?

We are getting there slowly, but surely. Up until 2014, indoor tanning devices had the same classification level as a bandage in the US. In England, these devices are rated the same as asbestos which says “this is a carcinogen.” Now they are Class II level in the US, which was a much-needed public health change. More needs to be done.

One solitary tanning session will increase risk of skin cancer by 67 percent, and for those under the age of 35, one session increases this risk by 75 percent. The World Health Organization, the American Medical Association, the American Academy of Pediatrics, and the American Academy of Dermatology have all called for a ban on ALL indoor tanning by minors. The FDA also recommends that no one under the age of 18 use these devices.

Presently, a handful of states have passed laws that ban the tan for those under 18; others have laws that prohibit minors from using indoor tanning devices, unless they have a prescription by a physician, and some states merely require a signed permission slip from a parent or guardian. We need to put indoor tanning salons out of business.

What role do you see for Mohs micrographic surgery in melanoma treatment?

Mohs micrographic surgery has its place, especially in removing basal cell and squamous cell carcinomas. It’s great for some melanomas especially those in cosmetically sensitive areas, but it is very expensive and needs to be used wisely and sparingly. It is one of many tools we have to treat skin cancer. n