Be wary of lesions on your skin

I was barely seven years old when The Sound of Music was released and took the world by storm, earning five Oscars.  I remember watching the movie in a fully-packed movie house with my mom carrying me almost the whole time.  The storyline:  Julie Andrews (a.k.a. Maria) was a novice at a strict Salzburg convent.  She loves the Alps and often goes hiking there at the expense of her religious duties. So, the Mother Abbess thought Maria might be better suited for a life outside of the convent and decides to send her to be governess to the seven children of Captain Von Trapp, a distinguished and widowed naval officer.

Upon Maria’s arrival at the Von Trapp home, she’s quite flabbergasted at the military discipline, which the Baron exercises over his children. She also discovers that she is the latest in a long line of governesses that the children have driven away.  Maria proves to be a different governess: instead of being controlling to the children, she introduces music into their lives.  And you probably know the rest of the story of this all-time favorite movie that’s as alive today as the hills of Salzburg.

My visit to Salzburg sent me down memory lane via this well-loved movie. I was there to attend a convention on the latest advances in the diagnosis and treatment of common and rare skin cancers. The highlights were as follows:

• Merkel Cell Carcinoma — a rare and very aggressive neuroendocrine skin cancer regulated by the immune system and associated with fair skin, advanced age, immunosuppression and UV radiation.  Still no cure but reported median overall survival in two of five studies is 9 to 9.5 months.  Latest drug being used to treat MCC belongs to the family of immune checkpoint inhibitors avelumab.  Avelumab is a drug that blocks certain proteins made by some types of immune system cells, such as T cells, and some cancer cells. These proteins help keep immune responses in check and can keep T cells from killing cancer cells. When these proteins are blocked, the “brakes” on the immune system are released and T cells are able to kill cancer cells better. But even with this, there is still no cure for the advanced disease. Avelumab is only chemopalliative (meaning it just calms the tumor but does not cure it) with a median survival of approximately nine months.

• Malignant Melanoma — can masquerade as benign dermatoses in the form of: keratoacanthoma (bukol), intertrigo (katikati sa singit), lichenoid keratoma (appears to result from the inflammatory destruction of a pre-existing epidermal lesion such as a solar lentigo or dark round spots on the face and arms of the elderly) or seborrheic keratosis (genetic warts), diabetic foot ulcer or eczema.  These atypical presentations are usually associated with poor outcome.

Occurrence of vitiligo (white spots) in melanoma patients has been associated with metastasis.  A case series by Nordlund, et al showed that 49 of 51 melanoma patients with vitiligo eventually had metastases.  The depigmenting phenomenon is thought to reflect the immune response against melanoma.  Normal melanocytes are innocent bystanders while the immune responses destroy melanoma cells.

No treatment for disseminated, nonresectable melanoma (meaning cannot be surgically removed because it is no longer confined to one place) had ever shown benefit in any randomized phase III trial.   Vaccine is useful only in the absence of disease but once melanoma is present already, vaccine cannot help.

• Basal Cell Carcinoma — relatively considered as a non-scary skin cancer, but once it is metastatic, it becomes aggressive and is deadly.  It is the most highly mutated cancer (any change in the DNA sequence of a cell). Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment (like sunlight). Mutations can be harmful, beneficial, or have no effect. If they occur in cells that make eggs or sperm, they can be inherited.  If mutations occur in other types of cells, they are not inherited. Certain mutations may lead to cancer or other diseases.

So, my advice is to be wary of lesions on your skin, especially if you are fair-skinned, immunocompromised, elderly, sun-loving and with a family history of any form of cancer.  Remember that an ounce of prevention is worth a pound of cure.

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For questions or inquiries, call 09174976261, 09998834802 or 263-4094; email gc_beltran@yahoo.com.