The Melanoma Letter

SUMMER 2010 Vol. 28, No. 2

In this issue of The Melanoma Letter, we address the developments underlying a recent flurry of media attention and public policy action related to artificial ultraviolet (UV) tanning devices. A major impetus for all this attention was the extensive, authoritative report on the subject prepared by the International Agency for Research on Cancer (IARC), a working group affiliated with the World Health Organization (WHO).  We are very grateful to Dr. Philippe Autier, who headed up the Unit of Prevention Evaluation that issued the report, for providing an outstanding synopsis of the science covered in the 64-page document, which concluded that artificial tanning devices are carcinogenic in humans.

In a companion piece, we share some of the exciting tanning bed policy changes occurring internationally in response to the WHO’s addition of these devices to Group I, its most dangerous cancer category. The data affirming the risks of tanning beds has continued to mount since the IARC review. The rapidly growing evidence supports the blanket recommendation of a recently released FDA educational video: “Avoid using device-generated UV sources such as tanning beds entirely.”

• Nations Unite Against Tanning: The Impact of the IARC Report
• Carcinogenic to Humans: Why the International Agency for Research on Cancer Added Indoor Ultraviolet (UV) Tanning to Group I
• From the Editors SUMMER 2010, Vol. 28, No. 2

SPRING 2010, Vol. 28, No. 1

In this issue of The Melanoma Letter, Bradley Bloom and Dr. David Polsky identify another high-risk gene called MDM2, which when mutated, and in the presence of estrogen, may increase a woman’s propensity for developing melanoma, especially at younger ages. If their findings are substantiated, it may help explain why younger women have higher melanoma incidence than younger men.

Based on the articles in this issue of The Melanoma Letter, it is compelling to contemplate just when clinical practice will evolve from the current phenotype-based screening and disease-based therapy to molecular/genetic-based targeted screening and therapy.

• First Evidence: Targeted Melanoma Therapy May Change the Landscape of Treatment
• Melanoma in Women Under Age 50: Can Genetics Work with Estrogen To Boost Risk?
• From the Editors SPRING 2010, Vol. 28, No. 1

FALL / WINTER 2009, Vol. 27, No. 3

In this issue of The Melanoma Letter, Dr. Shawn Allen presents a thorough, balanced overview of this complicated and clinically important topic. While presenting the issues raised against widespread screening, Dr. Allen explains why it is so intuitively attractive for melanoma. He also summarizes recent studies supporting melanoma screening that were unfortunately not yet available or not considered when the USPSTF made its latest recommendations.

In a companion piece, Dr. Allen explores the integrally related concept of overdiagnosis. Acknowledging the growing recognition in both the scientific literature and the public media that overdiagnosis is a legitimate concern, he calls for tempering our approach to cancer screening in general and melanoma screening in particular. The very ease with which melanoma lends itself to early detection by simple visual inspection holds both the promise of effective screening and the risk of overdiagnosis.

• FALL / WINTER 2009, Vol. 27, No. 3 - From the Editors
• Melanoma Screening Saves Lives
• A Question of Overdiagnosis

SUMMER 2009, Vol. 27, No. 2

This issue of The Melanoma Letter is dedicated to one of the less common skin cancers, Merkel cell carcinoma (MCC). This potentially lethal cancer – more frequently fatal than melanoma – was recently featured in headline news worldwide due to the landmark discovery that viral oncogenesis may be responsible for triggering its development. Evidence is mounting that, much the way human papillomavirus induces cervical cancer and herpesvirus induces Kaposi’s sarcoma, a mutated polyomavirus may induce the majority of Merkel cell carcinomas.

In our lead story, Dr. Jürgen Becker presents an excellent review of the epidemiology, pathogenesis, staging and current treatment options for Merkel cell carcinoma. In the accompanying report, the evidence linking a polyomavirus to Merkel cell carcinoma and the fascinating process by which this evidence was uncovered are described in detail by Drs. Moschos, Chang and Moore, integral members of the group that discovered the role of this polyomavirus in MCC. It is the shared hope of researchers and clinicians that their discovery will lead to a better understanding of MCC and successful therapies.

• From the Editors Vol. 27 No. 2
• Merkel Cell Carcinoma
• Merkel Cell Polyomavirus: The Seventh Human Cancer Virus?

SPRING 2009, Vol. 27, No. 1

In this issue of The Melanoma Letter, Drs. Isaac Brownell, Nancy Lee, and Alice Ho at Memorial Sloan-Kettering Cancer Center explore the uses of superficial radiotherapy in treating certain types of melanoma. The technique can serve as an adjuvant therapy to regional lymph node basins in select patients at high risk for regional recurrence, as a palliative therapy for disseminated inoperable disease, and in select cases, as a primary therapy for lentigo maligna and lentigo maligna melanoma as well as unresectable in-transit metastases. On page 3 Dr. Reinhard Dummer details the experience of European clinicians using superficial radiotherapy to treat LMM.

WINTER 2008, Vol. 26, No. 4

In this issue of The Melanoma Letter, Dr. Steven Rosenberg of NCI shares with us his innovative treatment method of adoptive cell transfer, which entails harvesting a melanoma patient’s own tumor-infiltrating lymphocytes (TIL) and isolating the cells expressing T cell receptors that can recognize melanomaspecific antigens. These cells are grown in large numbers and re-injected into the patient with the goal of targeting the patient’s melanoma cells.

In an accompanying article, Drs. Jedd Wolchok and Stephanie Terzulli present another potentially more generalizable approach to harnessing T cells for melanoma therapy. They describe their experience with the use of antibodies to CTLA-4 in the treatment of advanced melanoma. By preventing T cell inhibition, anti-CTLA-4 therapy unleashes the immune system to permit more robust T cell activity against melanoma.

In addition to yielding ‘cures’ for some patients, these therapies are providing significant insights into the interplay of different subsets of T cells, which will hopefully lead to more effective, generalizable, and safe therapies for advanced melanoma.

Allan C. Halpern, MD, Editor-in-Chief
Ashfaq A. Marghoob, MD, Associate Editor

FALL 2008, Vol. 26, No. 3

In this edition of The Melanoma Letter, we diverge from our usual attempt to provide objective coverage of clinical advances and important research. Instead, we have invited Dr. Vivian Bucay to provide a detailed and very personal account of her battle with melanoma over the past two years. Her insights as an expert coupled with her experiences as a patient give her report a powerful immediacy as she touches on the wide range of diagnostic tests and treatments, both traditional and experimental, currently available for metastatic melanoma.

While we often lament in these pages the lack of highly effective treatments for advanced melanoma, Dr. Bucay’s story personalizes the hopes of patients and their physicians in their search for effective therapies.While to date the majority of patients may find improved diseasefree survival at best, some persistent, fortunate souls will indeed experience remission and even dare we say “cure.”

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