Skin cancer comes in three different forms: basal cell carcinoma, squamous cell carcinoma, and melanoma. BCC and SCC rarely prove fatal (although sometimes they do kill). The one to watch for is melanoma.

Melanoma accounts for most of the deaths from skin disease, and over 90% of the deaths from skin cancer. Its incidence is increasing, particularly among people who are young and otherwise healthy. When caught early, the survival rate is 99%. When it has spread, the 5 year survival drops to 10% (or lower, depending on whose study you read). 50% of patients die within 6-9 months. There is no cure. Melanoma laughs at chemotherapy and shrugs off radiation. Surgery can remove some tumours, but the cancer returns in most cases. Some new drugs have shown promise–but the lead time for development is looooong, and new treatments in trials likely won’t help you if you’re diagnosed with Stage IV melanoma–remember that 6-9 month timeline? Yeah . . .

Melanoma affects different groups of people. The people most likely to develop it are white males living in tropical latitudes. If this is you, then pay attention to your skin. If you sunbathe, if you have a history of peeling sunburn, if you work outside, if you go swimming in bright sunlight a lot, if you live in a tropical latitude (yeah, MUIC staff, I’m looking at you!), then you need to start checking your skin for possible signs of melanoma. It won’t take long, and if you catch it early, you’ve got nothing to worry about.

Signs of melanoma can be found here:http://www.cancerresearch.org/resources/conquering-melanoma/p2.html

You should check every couple of months. Yes, I know that’s frequent, but some nodular melanomas grow like bitches. If you check every six months, you could have a cancer form, burrow into your skin, and spread. By the time you check, it’ll be too late.

If this sounds like I’m trying to scare you, good. This is one of the things you should be checking for, same as blood when you pee or take a dump, or spells of dizziness for no reason, or any of the other signs that *could* be a sign of something major. (They’re probably not, but hey, better safe than sorry, right?)

Of course, you could just blow it off and say there’s no history of skin cancer in your family so you’re probably safe. And you might end up like me. Young (35 when it started), perfectly healthy, exercised a lot, healthy weight, ate right, family history of cancer limited to bowel cancer in a grandparent and lung cancer in an aunt (who smoked 20/day for 30 years) . . . and diagnosed with metastatic melanoma in August, 2009. Since then I’ve had four surgical procedures to remove tumours (long scars on my legs, groin, belly, and under one arm, neuropathy, internal scarring, etc. etc.), I’ve had my brain blasted with radiation (hair falling out, vomiting, confusion, probable early onset of dementia, memory loss, etc. etc.), I’ve developed an ulcer and Barrett’s esophagus from the drugs given to me, and generally my life has been turned upside down and stamped on. Hard.

But if none of that worries you, then go ahead and ignore any changes to your skin. Probably just a freckle anyway. Right?

. . . but as usual, it’s years away. Treatments like this come into view fairly regularly, but then almost always sink during the clinical trials. Maybe this one will be different.

Breakthrough Hope for Melanoma Blocker – RA Drug Singled Out from Thousands Screened

ProHealth.com
April 1, 2011

“We are very optimistic that this research will lead to novel treatments for melanoma tumors which, working alongside other therapies, will help to stop them progressing.”

A breakthrough discovery by researchers at the University of East Anglia and Children’s Hospital Boston promises an effective new treatment for one of the deadliest forms of cancer.

As reported Mar 24 in the journal Nature(1), they found that leflunomide – a drug commonly used to treat rheumatoid arthritis – also inhibits the growth of malignant melanoma.

More.

(AP) – 2 days ago

WASHINGTON (AP) — The Food and Drug Administration has approved a breakthrough cancer medication from Bristol-Myers Squibb Co. that researchers have heralded as the first drug to prolong the lives of patients with melanoma.

The federal health agency approved the injectable drug, called Yervoy, for late-stage or metastatic melanoma. The agency has only approved two other drugs for advanced melanoma, the last of which was cleared more than 13 years ago. Neither drug has been shown to significantly extend patient lives.

Known chemically as ipilimumab, the biotech drug only worked in a small segment of patients studied, and on average they lived just four months longer than patients given older medications. But experts say the drug is an important milestone in treating the deadliest form of skin cancer, which is often unresponsive to therapy.

“Clearly this is not a home run, but it’s a solid base hit,” said Tim Turnham, director of the Melanoma Research Foundation. “And because we see other things in the pipeline, we think this the first in a series of important new therapies for melanoma.”

More.

Well, it’s good that the FDA approved it. It’s not a cure–except possibly for a minority of patients–but it is far better than the current treatments, which are frankly pretty useless. It’s still in progress with the NHS, but I don’t imagine it will take too long before it’s approved for use in the UK as well.

FDA Approval Expected this Month for Ipilimumab

By: BRUCE JANCIN, Skin & Allergy News Digital Network

More.

***

Worth a read, especially for some of the peculiar responses people have had to the drug (tumours growing and/or new sites of metastasis before stabilization). And also there are the usual dismal survival stats:

“The 12-month survival rate was 46% with ipilimumab alone, compared with 25% with vaccine only; the 24-month survival rates were 23% and 14%. Median overall survival was 10.0 months with ipilimumab plus vaccine, 10.1 months with ipilimumab alone, and 6.4 months with vaccine only”

Median survival 10 months. And that’s an improvement. Melanoma is a very nasty cancer once it’s spread. I was diagnosed with Stage IV melanoma in August, 2009. That’s 19 months ago. I am lucky to still be alive.

Post from the NZ Herald:

Drugs give hope to melanoma patients

 A cancer researcher has predicted that advanced melanoma patients could survive the disease within five years, thanks to dramatically improved drugs.

Malignant melanoma is the most deadly form of skin cancer and New Zealand’s fourth most-common cancer. The country has one of the world’s highest incidence and death rates from malignant melanoma.

Each year, more than 2000 new cases are diagnosed and more than 250 people die from the disease.

If a melanoma is detected early it is readily treated by surgery. Of patients diagnosed with a tumour just 1mm thick and whose cells haven’t spread, more than 90 per cent will be alive five years later. But in cases where it has spread to organs before detection, fewer than 10 per cent are alive after five years.

However, a melanoma conference in Wellington yesterday heard hopeful news about the progress of drugs in clinical trials for patients with disease that has spread – metastatic melanoma.

“These advances offer the realistic promise of our being able to convert metastatic melanoma from a death sentence to a chronic disease within five years,” said Professor Richard Kefford, the director of the Westmead Institute for Cancer Research at Sydney University.

Read more.

I think the article is a bit too hopeful regarding the time frame, but this is certainly the way cancer treatment is heading. At the moment, though, melanoma treatment is not very effective. I really have no idea when/if these drugs are going to come into widespread use, but it will probably be too late to have any effect on me (either I’ll survive without them, or I’ll die before they are around).

An interesting news item today. Apparently a group of researchers at Sloan-Kettering in New York have developed a nano-particle that seeks out and sticks to melanoma cells.It’s non-toxic, and emits bright infra-red light. The pic in the article shows the technology being used to highlight a melanoma tumour in a rat.

This is interesting, as it’s the first time that the spread of melanoma can be imaged so precisely. This more more precise and less invasive surgery, and fewer complete lymphadenectomies like mine. And of course, once you’ve developed nano-particles that track and adhere selectively to melanoma cells, it’s not too much of a stretch to imagine piggybacking something that kills melanoma on the back of these nano-particles. You’d then have something that targets and kills melanoma, while leaving healthy cells untouched. A cure? Sounds like it to me . . .

Some interesting news about melanoma treatments came in to my inbox (as well as the usual frankly dismal survival stats).

A diagnosis of melanoma is very bad news: Millimeter per millimeter of tumor, it’s among the deadliest cancers. Typically first appearing as a dark, irregular skin lesion, it can spread rapidly to every organ. There are some 68,000 new cases of melanoma in the United States each year, and the incidence is growing, despite warnings to stay out of the sun or wear sunblock to minimize exposure to ultraviolet radiation, the disease’s most important risk factor. Highly curable if found early, melanoma grows aggressively if undetected. Nationwide the cancer kills almost 9,000 people a year, mostly those with fair skin, often in the prime of life and frequently within mere months of discovering that their cancer has metastasized far and wide.

The best hope is a harrowing treatment for which only the fittest patients qualify: intensive immunotherapy that uses high doses of interleukin-2 (IL-2), a potent immune hormone. IL-2 therapy requires multiple hospital stays, during which patients receive intravenous infusions several times a day. The catalogue of side effects includes a racing heart, flulike chills, decreased blood pressure, vomiting and diarrhea, and edema, which can cause 10 to 20 pounds of weight gain.

Even then, no more than 20% of patients who get the treatment benefit, though 6% appear cured for life. Still, immunotherapy is better than the only other Food and Drug Administration-approved treatment for advanced melanoma: Chemotherapy with dacarbazine gets only a 10% response rate, and patients survive an average of just seven months.

Keep reading.

Training the immune system to recognize melanoma cells seems to be one of the most promising of the two prongs of research into new treatments for the disease. (The other being switching off genes in the tumour.) I’ve been reading a lot about these results in the news, so thought I’d post a link to a summary.

WEDNESDAY, Feb. 2 (HealthDay News) — A T-cell receptor (TCR)-based gene therapy directed against NY-ESO-1 cancer/testis antigen may represent a new therapeutic approach for patients suffering from melanoma and synovial cell sarcoma, according to a study published online Jan. 31 in the Journal of Clinical Oncology.

More.

This is my current schedule for races:

Sunday 6th Feb: Watford Half Marathon

Sunday 6th Mar: Berkhamstead Half Marathon

Apr: [training]

Sunday 1st May: 3 Forts Marathon

Sunday 19th June: Torbay Half Marathon

July: undecided. Either Trailwalker or the Fairlands Valley Challenge Ultra 50

Sunday 14th August: Salisbury 5-4-3-2-1

September: New Forest Marathon (not yet open for entries)

Saturday October 29th: Snowdonia Marathon

Nov: Luton Marathon / BKK marathon (depending on funds)

Dec: nothing yet (but there will be).

Depending on how feel during the training, i may try and squeeze in a couple of 10ks or half marathons during the training only months (and other places if I can fit them into the program).

So why so much this year? I think ‘Fuck Cancer’ is a good enough reason. If I’m going to die, it’s going to be in a blaze of fucking glory. Melanoma can kiss my hairy ass.

Edited to add dates and the Torbay Half.

One of the operations I’ve had was to remove the lymph nodes from under my right arm (happened in April 2010). They warned me before the operation that there might be permanent side effects, one of which was nerve damage. After the op, I had patches of numbness down the back of my arm. Sometimes they prickled when touched, like pins and needles. At other times, they were just completely numb. Nine months later, it’s now settled down to lessened sensation down the back of my arm . . . and a patch of complete numbness in my armpit. It’s odd. it doesn’t feel like numbness from an anaesthetic, like when you go to the dentist and get a numb face (it’s numb, but you can feel it feeling numb, if that makes sense). It’s more like a hole in my body awareness.

So now when I put on deodorant, I spray my left armpit and get a cold feeling where the spray hits. You know that, right? It’s how you know you’re spraying in the right place. But when it comes to my right armpit, I feel nothing. If I’m feeling sleepy, I only stop when I start smelling the deodorant–and given my crappy sense of smell, that’s about the time my wife wakes up and starts yelling at me for stinking out the bedroom.

Not upsetting, like many things about cancer. Just . . . odd.