PracticalDermatology

Dr. Hensin Tsao is an internationally recognized expert on melanoma. In addition to serving as Director of the Massachusetts General Hospital Melanoma and Pigmented Lesion Center and Associate Professor of Dermatology at Harvard Medical School, he has authored numerous articles, reviews, and textbook chapters, as well as presented at numerous conferences on melanoma, genetics, and skin disease. Ahead, Dr. Tsao shares insights on the state of melanoma research and addresses the challenges of care going forward.

How would you describe the current state of diagnosis and treatment of melanoma?

“Melanoma is enjoying a tremendous renaissance with the extraordinary advances in innovation and technology,” says Dr. Tsao. “With genomic advances, comprehensive analyses of melanoma exomes and genomes will soon be possible for every individual and/or tumor specimen. Optical and nonoptical technologies will also allow in vivo biopsies to render point-of-care diagnostics so that surgical decisions can be made in real-time,” he continues. Therapeutic development has also blossomed, according to Dr. Tsao. “Several new highly effective drugs have been approved in the past two years and many more molecular and immunological agents are in the pipeline,” he observes. “I’ve never seen the field so rich with opportunities.”

What you see as the next big horizon in melanoma research?

“I think epidemiology will continue to move toward molecular profiles with larger genome-wide association studies and greater efforts to perform consortia-based studies,” says Dr. Tsao. “Risk factors for melanoma have been pretty well characterized, but initiatives are afoot to understand risk factors for lethal melanoma. There are hints already, such as older men with head/neck melanomas and nodular melanomas,” he notes, while the harms from tanning beds will continue to be an important aspect of melanoma risk, as well, he says. Another potentially interesting horizon, according to Dr. Tsao, is the opportunity that electronic health records may present. “With integrated electronic medical record systems, I expect that new associations will become easier to detect, since a complete medical profile will reside in electronic, and potentially discoverable, form.”

Going forward, what would you like to see emphasized more in research and practice?

“It truly is the best and worst of times for melanoma and all of research,” observes Dr. Tsao. “I think we are poised to really understand the inner workings of cancer, including melanoma, and yet funding from public sources is very much constrained.” The threat, in Dr. Tsao’s view, is that a generation of bright scientific minds may be lost to other professions and the private sector. “Nevertheless, I think melanoma therapeutics will continue to expand, as will melanoma genomics,” he says. In terms of technology, a better understanding of what is imminently adoptable in clinic in terms of costs and benefits will also be important, according to Dr. Tsao, as he believes the future of healthcare will certainly be constrained financially. “Do not be surprised if risk assessments through genetic testing enters the direct-to-consumer market in a profound way within the next 20 years.” Also, Dr. Tsao notes, as we have seen with social media and the Internet, consumers have tremendous power within their means. “I anticipate that hand-held devices and smartphones will become part of the melanoma landscape in the next decade in some limited but meaningful fashion,” he says. But in the end, what remains the most important aspect of melanoma prevention is not necessarily based in research or technology, according to Dr. Tsao. “Patient and parent education about sun protection and tanning bad use is essential; that, however, is a true cultural change.”