Treatments and therapies “What do you need to know” Melanoma Treatments and therapies “What do you need to know” Sandy Beam RN, OCN, CCRC Research Nurse Clinician Maryland Melanoma Center Franklin Square Medical Center Baltimore, Maryland

Sun damage done today may be tomorrows skin cancer. SKIN FACTS & FUNCTIONS Largest organ in the body 1st barrier to protect us from infection and injury, heat and light. * Regulates body temperature, Prevents dehydration, and Stores water, fat and vitamin D. Sun damage done today may be tomorrows skin cancer.

Skin Cancer Facts Primary cause is ultra violet (UV) rays from: excessive SUN exposure (UVB) tanning bed exposure (UVA) Over 1 MILLION new cases will be diagnosed this year. Melanoma = 121,740 Basal cell and squamous cell OVER 1 MILLION Can develop on any skin surface 95% are curable, with early detection and treatment SKIN CANCER DOES NOT DISCRIMINATE! Affects all ages, sex, ethnicities, and skin colors

SKIN CANCER FACTS 4 Types of skin CANCER: Basal cell carcinoma (BCC) most common,100% from UVB-sun and UVA-tanning bed, slow growth, rarely spreads Squamous cell carcinoma (SCC) caused by UVB and UVA damage. 1 out of 3 with disease will spread or metastasize to other areas of the body Merkel cell most lethal and least common MELANOMA is the 2nd most deadly skin cancer, but it is the more common killer of the skin cancers. Can develop on any area and spread or metastasize to any area of the body: skin, lymph nodes, organs

Moles, freckles and spots! Most are NOT cancer May not look pretty NEED to be observed for changes

Benign Hutchinson's Freckle has the potential to become cancer Benign nevus

How do I get skin cancer? RISK FACTORS Factors beyond our control….. Hereditary: what our ancestors gave us Fair or freckled skin Light hair: blonde, red or light brown hair Light color eyes: blue, green, or grey green Family history of melanoma or skin cancer Personal history of melanoma or skin cancer

RISK FACTORS Factors you can control may change your future UVB rays of the sun, #1 cause of skin cancer! FACTS 1 hour of daily sun exposure and adequate diet provides all the vitamin D we need. Tanning and burning increase production of melanin (pigmented cells of the skin) which can cause genetic damage to skin cells, may lead to skin cancer. Environmental exposures: chemicals, radiation, burns (scald, fire, chemical)

BUT I GET MY VITAMIN D!!!!!!!!!!!!!!!!!!!

RISK FACTORS Factors you can control may change your future UVA rays of tanning beds: FACTS 2-3 times more powerful and delivered in a shorter period of time, than natural UVA rays emitted from the sun penetrate the skin deeper (pre-mature aging) may damage eye sight + immune system Tanning and burning increase production of melanin (pigmented cells of the skin) which can cause genetic damage to skin cells, may lead to skin cancer. YOU CAN’T PROTECT THE SKIN BY DAMAGING IT! 7 out of 10 people age 16 to 30 who tan at least 10x year (not per month), will (not may) develop skin cancer

What do I look for! “ABCDE” ASYMMETRY - imaginary line mid lesion, no mirror image BORDER - edges are ragged, blurred or irregular COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly DIAMETER - change shape, size or gets larger than a pencil eraser (5mm) EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds GET IT CHECKED!

What do I look for! “ABCDE” ASYMMETRY - imaginary line mid lesion, no mirror image BORDER - edges are ragged, blurred or irregular COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly DIAMETER - change shape, size or gets larger than a pencil eraser (5mm) EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds GET IT CHECKED!

What do I look for! “ABCDE” ASYMMETRY - imaginary line mid lesion, no mirror image BORDER - edges are ragged, blurred or irregular COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly DIAMETER - change shape, size or gets larger than a pencil eraser (5mm) EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds GET IT CHECKED!

What do I look for! “ABCDE” ASYMMETRY – imaginary line mid lesion, no mirror image BORDER - edges are ragged, blurred or irregular COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly DIAMETER – change shape, size or gets larger than a pencil eraser (5mm) EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds GET IT CHECKED!

Where can melanoma appear ? Any skin surface in an old mole/lesion/spot or as a new spot or thing that just appeared, often on sun exposed areas Nail beds and cuticles Palm of hands and soles of feet, usually in dark skin people Mucous membranes of the oral, anal or vaginal canal Ocular or Uveal (retina of the eye) ** Unknown primary: not sure where it originated? MELANOMA can spread or metastasize to any area of the body, such as the lung, liver, ovaries, colon, rectum, nasal passages and brain.

Amelanotic (no pigment) nodular melanoma Satellite melanoma tumors

Mucosa melanoma tumor (inner lip) Cutaneous melanoma of eye lid

Subungal melanoma of nail bed Acral melanoma (nail bed)

Cutaneous (skin) melanoma of plantar aspect of foot

Melanoma Detection + Treatment 95% CURE with early detection and treatment! Ignore “it” and it will…… grow ulcerate smell spread to lymph nodes, lungs, liver, etc…

Melanoma in a lymph node Fungating melanoma mass

Treatment options Metastatic melanoma : 1st FDA approved treatment is high dose IL-2 (Proleukin) which is considered as 1st line treatment. Other options include: Yervoy (Anti-CTLA-4) Vemufenib (BRAF inhibitor) Clinical trial Adjuvant therapy is appropriate for melanoma that has been surgically removed: Standard of care is close follow-up. Other options include: Interferon Clinical trial

Treatment options Purpose of cancer treatment Administration of high-dose IL-2 requires careful attention to the many physiologic changes occurring in patients during treatment Treatment algorithms are useful tools in managing these patients but cannot replace the careful judgment and individualized decision making that is needed The health care team should be familiar with the scope of possible side effects that may be encountered, because they must be prepared for the common as well as unusual events that occur when treating patients with high-dose IL-2 Purpose of cancer treatment Palliative care Reducing the severity of disease symptoms Prevent and relieve suffering and to improve quality of life Curative care Treatment and therapies provided with an intent to improve symptoms and cure the patient's medical problem

Treatment options WHY CONSIDER PROLEUKIN? Proleukin may induce a durable, complete response1,2 Overall response rates (complete responses + partial responses) of 15% to 16% have been obtained with Proleukin therapy3 Proleukin is the ONLY approved therapy that has shown a complete and durable response in metastatic renal cell carcinoma or metastatic melanma. Median response duration for patients with a CR (7% metastatic renal cell carcinoma & 6% metastatic melanoma) is still not reached3: At 80+ months for metastatic renal cell carcinoma At 59+ months for metastatic melanoma

How can I reduce my risks of developing melanoma? REDUCE risk factors you can control! STAY OUT of the sun at peak times10am - 4pm AVOID- Do not use tanning beds Wear clothes to protect your skin: wide brim hat, cotton pants + shirt, sunglasses Apply Sun block protection: SPF30 or higher Apply 20-30 minutes before you go in the sun! Beaches OR Ski slopes. Re-apply a least every 2 hours OR after swimming, exercising OR heavy sweating. Perform routine self skin exams Education gives YOU the power to prevent skin cancer!

“UVSP” UltraViolet Ray Skin protection EDUCATION is the key! Reduce risk factors Avoid excessive sun Avoid tanning beds Apply sun block Self skin exams ABCDE’s “Slip” on a shirt “Slap” on a hat “Slop” on sunblock

You said to wear a HAT