Question

10. Describe some of the current advances in the early detection of skin cancer. Current advances refer to the new therapies, protocols, diagnostics, etc. that are under review or have just been approved by agencies such as the FDA. 11. What are the different types of melanomas? 12. Which structures of the skin are involved in the development of melanoma? 13. What is microstaging and why it important? 14. Describe the different criteria for staging melanoma. 15. Describe the prescribed treatment modalities for melanoma 16. Describe some of the alternative treatment options for melanoma 17. As a concerned friend of Lisa and Anthony, how will you help the couple deal with this serious medical situation?

Answer 1

10) Current advances in cancer detection:

Immunotherapy:

- Immune system hunts down and kills invaders like bacteria and viruses. It also seeks out and destroys cancers as they form. But cancer has developed ways to hide from your immune system. It can grow despite your body’s efforts to stop it.

Immunotherapy helps your immune system attack the cancer. This treatment works in several ways, including:

• Preventing the cancer from hiding
• Boosting your immune response against cancer

There are several immunotherapy treatments in the works right now:

Checkpoint inhibitors: Immune system has fighters called T cells. They seek and destroy foreign cells, including cancer. Healthy cells have proteins called checkpoints on their surface that let the fighters know they're friendly.

Cancer cells sometimes use checkpoints to hide from your immune system.

Immunotherapy drugs called checkpoint inhibitors block checkpoints on cancer cells to help T cells find the cancer. Checkpoint inhibitors treat several types of cancer, including bladder, colorectal, head and neck, kidney, liver, lung, lymphoma, melanoma, and stomach.

Monoclonal antibodies. Your immune system makes proteins called antibodies to help it spot invaders like bacteria and viruses. Each antibody seeks out another protein, called an antigen, on the surface of an invading cell.

Monoclonal antibodies are designed in a lab to target antigens on cancer cells. Some help your immune system find the cancer. Others are attached to a toxic substance that kills the cancer.

Adoptive cell transfer. This method uses your own immune cells to treat your cancer. Doctors take the cells from your blood or tumor. They modify them in a lab so they will be better able to bind to and attack cancer cells. CAR T-cell therapy is one type. It’s approved to treat certain kinds of leukemia and lymphoma.

Immune system modulators. They boost your body's immune response against the cancer. An example is cytokines -- substances that control immune cells' growth and activity. Examples include:

• Interleukins,which help immune cells communicate with each other
• Interferons,which activate cancer-fighting immune cells

Cancer vaccines. Just like vaccines help your body find measles or polio viruses, cancer vaccines help your immune system find cancer cells.

Vaccines are made from your cancer cells. Doctors take them out of your body and use them to make the vaccine. Once it’s ready to help your cells find and attack the cancer, it goes back into the body.

One cancer vaccine, sipuleucel-T (Provenge), treats prostate cancer that has spread. Other vaccines against breast, lung, and brain cancers are being studied in clinical trials.

Preventive vaccines are available to guard against human papillomavirus (HPV) and hepatitis B, which can lead to liver cancer.

Finding an effective cancer vaccine has proven more difficult than researchers had thought. Because cancer cells have many ways to hide from your immune system, they can be hard to track down.

Researchers are now looking at more effective ways to give cancer vaccines. One method is to combine them with substances called adjuvants to help them work better.

Gene-Based Treatments

Cancer research no longer follows a one-size-fits-all approach. It's become much more personalized, with research on genes driving the trend.

Doctors now know that one cancer -- like breast or lung cancer -- can come in many different genetic types.

Genomics, the study of changes to genes in your DNA, is giving doctors important clues about how your cancer will act and how to best treat it. Doctors look for changes called mutations in certain cancer genes.

Finding these mutations can help them:

• Diagnose the cancer
• Predict your outcome
• Determine which drug or other treatment will work best on the cancer
• See how well the treatment is working

Gene-based treatments work for people with specific gene changes in the cancer. For example, the drugs vemurafenib (Zelboraf), dabrafenib (Tafinlar), and encorafenib (Braftovi) treat people with melanoma who have a gene mutation known as BRAF. The drugs stop the overproduction of BRAF protein that the mutation causes. Trastuzumab (Herceptin) works the same way against breast cancers that overproduce the HER2 gene.

11) There are four main types of skin melanoma:

• Superficial spreading melanoma is the most common type. It is more commonly found on the arms, legs, chest and back.
• Nodular melanoma is the second most common type
• Lentigo maligna melanoma is less common.
• Acral lentiginous melanoma is the rarest type.

12) Most skin cancers develop from cells found in the epidermis layer of the skin. Keratinocytes are the main cells in this layer. It is also the route that skin cancer cells can use to spread around the body. The lymph nodes act as filters and catch these cells.

13) Microstaging is a technique used to help determine the stage of melanoma and certain squamous cell cancers. A sample of skin that contains tumor tissue is examined under a microscope to find out how thick the tumor is and/or how deeply the tumor has grown into the skin or connective tissues.

- Malignant tumour or melanocyte cells that are derived from the neural crest.

- Predominantly occurs in adults.

- Early signs are in a nervous include darker or variable discoloration, interval increase in size, nodularity and symptomatology: itching, ulceration, or bleeding.

- Excisional biopsy is required. There is no rule for incisional biopsy or shave biopsy and an experienced dermatopathologist is required for proper microstaging.

- Progress is affected by clinical and histological factors.

- Histological features: thickness or level of invasion, mitotic index, presence of tumor infiltrating lymphocytes, satelitosis.