early detection of melanoma skin cancer can make world of difference in treatment
even though laura crane had regular checkups with her dermatologist, a biopsy on a spot on her back confirmed a stage iii melanoma diagnosis.
5 minute read
laura crane with her supportive family. supplied
laura crane was diligent about skin health. her father had been diagnosed with melanoma, so she made it a priority to book regular checkups with her dermatologist. when she noticed a spot on her back that had changed slightly, she had it checked out. the doctor removed it the next day, and later, a biopsy confirmed a stage iii melanoma diagnosis. some of her lymph nodes also tested positive for the disease – an indication that the cancer was spreading.
crane, who lives in thunder bay, ontario was disappointed that at the time, interferon — a form of immunotherapy — was the only treatment option that was available to her. her father had received it, and she knew that in terms of outcomes, “the numbers weren’t amazing.” crane searched for alternative treatment options and even travelled to the mayo clinic in the u.s. for a consultation. at the same time, she learned that there was a clinical trial that was being established at sunnybrook hospital in toronto for patients with advanced melanoma.
crane met all the criteria but was selected to receive the novel treatment through a lottery system, which is established to allow every patient an equal chance of entering the trial. crane was the first person in canada to be enrolled in a trial that offered pembrolizumab – an immunotherapy treatment for advanced melanoma. fortunately, she responded well and didn’t experience any side effects, but at the recommendation of her oncologist, crane stopped working prior to starting the year-long treatment.
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melanoma is a serious form of skin cancer that can spread to lymph nodes and other parts of the body, and while people with a fair complexion and a family history of the disease are most at risk, those with darker skin tones can also get melanoma. an irregular border, uneven or odd colour, and an evolving shape are some of the telltale signs of melanoma, but a mole that is itchy or bleeds could also point to skin cancer. while melanoma is the most serious form of skin cancer, catching it early can help improve outcomes.
dr. parneet cheema, the medical director of cancer care and head of cancer research at william osler health system says that research and clinical trials play a pivotal role in positive patient outcomes. she says that in the last decade, there have been significant advances in treatment of melanoma.
“around the 2010 era, the average survival for patients with advanced melanoma was only six months and anything we did, it wouldn’t really change that outcome,” says cheema. “since then, we’ve made a lot of progress with immunotherapy and targeted therapy.”
laura crane was the first person in canada to be enrolled in a trial that offered pembrolizumab – an immunotherapy treatment for advanced melanoma. supplied
according to cheema, there is data that shows that immunotherapy and targeted therapy allow patients with advanced melanoma to successfully manage the disease five and even ten years after their initial diagnosis. individuals who don’t respond well to one treatment are offered other options — for example, if a patient isn’t responding well to targeted therapy, they may receive immunotherapy or vice versa, and in some cases, radiation may be offered to some patients. cheema says that for early-stage disease that is limited to the skin or if it has spread to regional lymph nodes, the goal of treatment is to reduce the odds of disease recurrence after surgery, but at the advanced stage, immunotherapy can offer “durable long-term control.” and while over the past decade, clinical trials have led to better, more effective treatment options for patients, according to cheema, there is still one major shortcoming of melanoma treatment.
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“we haven’t cured melanoma 100 per cent and until we’ve done that, we haven’t done our job,” she says. “there’s a lot more research to be done to get to that point.”
cheema suggests that the future melanoma research will focus on studying different types of immunotherapies, such as cell-based immunotherapy as well as antibody-based immunotherapy, and it may also include treatment options with fewer side effects — because skin cancer treatment doesn’t include chemotherapy, patients don’t experience hair loss, but they may experience other side effects of treatment, such as a rash or fever, which may occur with targeted therapy. similarly, immunotherapy, which uses a patient’s own immune system to fight the cancer, may put their immune system into overdrive, and if this occurs, steroids can help manage the immune system and hormone glands may also be replaced if they have been impacted, according to cheema.
backlog of cancer diagnoses
helena sonea is the director of advocacy at the canadian cancer society, and she says that because of covid-19, there has been a backlog of cancer diagnoses, including that of the skin. and while there’s isn’t a stigma attached to skin cancer per se, people like crane who are diagnosed with melanoma face other challenges, including the financial burden that is caused by stopping work to receive treatment.
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“what we do see pretty consistently is people with cancer having to pay out of pocket for various expenses, and some may also have difficulties accessing treatment.”
for the past five years, the organization has been advocating for an extension to employment insurance sickness benefit from 15 to at least 26 weeks of paid time away, and it has made additional recommendations, including revising the eligibility criteria, decreasing the threshold on the number of hours worked, and increasing support to workers impacted by cancer.
“we were thrilled to see in the federal budget an extension to sickness benefits be announced,” says sonea. “this is a practical support around finances that will impact hundreds of canadians who have all different types of diseases, including cancer. we anticipate this change to ei to happen later this year.”
sonea says that finding skin cancer early can make a world of a difference in disease management and in some cases, it could also prevent recurrence. she recommends that canadians enjoy the sun but that they take certain steps to protect their skin and eyes against sun damage year-round, which could include checking the uv index on a daily basis, wearing sunscreen — 30 spf or higher — and wearing protective clothing and a wide-brim hat in the summer months. sonea also suggests that checking the skin for any new marks or moles and scheduling regular skin evaluations with a family physician or a dermatologist are critical in early detection and prevention of skin cancer.
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reflecting back on her experience with melanoma, crane says that as a mom, she prioritizes sun safety for her children and family, but strives to strike the balance between ensuring that her kids are sun-safe without having them feel anxious about it. sun protection and regular skin checkups should be prioritized in the same way that most people understand the importance of exercise, healthy eating and seatbelt safety, says crane. according to her, sun protection doesn’t have to be complicated – it just needs to be consistent.
“anyone can be a victim of sun damage, and people need to be aware of what to look for,” warns crane. “putting on sunscreen and wearing a hat doesn’t decrease your enjoyment in the sun.”
maja begovic is a toronto-based writer.
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