I find it mildly ironic that skin cancer is having a bit of a moment just at a time when I’m spending some quality time with my dermatologist. Headlines lauding a new vaccine for melanoma sufferers and an immune-boosting topical cream to ward off squamous cell carcinoma don’t pertain specifically to my particular version of the disease, but they do lend some perspective for a guy heading into a couple rounds of Mohs surgery.
In other words, it could be worse.
Several months ago, I noticed a weird nodule above my right ear that seemed to be flaking and bleeding for no apparent reason. This had occurred around the same time that my sister-in-law had been diagnosed with a case of melanoma on her scalp, a coincidence sobering enough to persuade me to schedule an appointment. The earliest I could see someone, however, was a couple of months away, and by then that knob on my own scalp had ceased acting up, so I canceled the visit.
I am not what you would call a proactive healthcare consumer, so it took a few more months — and the emergence of other, more familiar, types of lesions — to convince me to once again pursue treatment. Meanwhile, a second nodule had emerged near the first troubling one near my ear.
The initial exam revealed three lesions, all of the less serious basal cell carcinoma variety. A full-body exam a week later identified one other of the same type. And the nodules on my scalp? Nothing to worry about, the doctor said, explaining the benign characteristics of something called a seborrheic keratosis.
“One of our nurses will call you to schedule Mohs surgery,” she noted on her way out the door.
While awaiting that call, I sampled some of the hype around a vaccine reputed to significantly reduce the risks of melanoma. The Washington Post noted that the drug, intismeran autogene, “could usher in a new wave of cancer treatment.” The New York Times hailed its potential as “the first vaccine of its kind used to treat cancer.”
The drug, developed by Big Pharma giants Moderna and Merck, uses messenger RNA (mRNA) that matches the genetic profile of the patient’s cancer tumor as part of a customized treatment protocol. To boost its effectiveness, the vaccine is paired with an existing immunotherapy drug. And in a phase 3 clinical trial involving 157 randomly assigned patients with a melanoma diagnosis, the vaccine cut the chances of a recurrence or death by 42 percent when compared with patients undergoing standard treatment. It also showed an ability to stop the cancer from spreading, reducing that risk by 38 percent.
“These results reinforce our conviction that mRNA has the potential to fundamentally change how we treat cancer,” Moderna CEO Stéphane Bancel noted in a statement released last month.
Maybe or maybe not, says Robert Vonderheide, MD, director of the Abramson Cancer Center at the University of Pennsylvania. “This is a first step,” he tells the Times. “Will it work in other tumors? I’m hopeful. Do we have a lot to learn? For sure.”
Meanwhile, over at Penn’s Perelman School of Medicine, Brian Capell, MD, PhD, is hailing the development of a topical cream that uses the body’s own immune response to attack cutaneous squamous cell carcinoma. “Ideally, this cream could be used directly on cancerous and precancerous spots,” he says.
In a preclinical study involving lab mice, Capell, an assistant professor of dermatology, and his team focused on inhibiting an enzyme, LSD1, that obstructs immune-activating pathways in epidermal cells. By blocking LSD1, the drug allows those skin cells to call for help from the immune system, which can slow tumor growth.
“[F]rom embryonic development through cancer progression, LSD1 functions as a master regulator of skin biology through coordinated control of differentiation, retinoid, and immune signaling networks,” Capell writes in JCI: The Journal of Clinical Investigation. “Topical epigenetic therapies could present a powerful and easily applicable tool for rewiring immune responses in skin cancer, avoiding drawbacks associated with surgical excision or systemic chemotherapy.”
Speaking of chemotherapy and topical creams, my biopsy results revealed that one of my cancerous lesions will not even require surgery. My doctor simply sent me to the pharmacy for a tube of fluorouracil, which I’m to dab on the spot above my right eye twice a day. This treatment approach, I learned, is favored when the tumor is superficial, low risk, and located amid several precancerous lesions.
This seems rather revolutionary: The gel works like chemotherapy, disrupting the growth of abnormal skin cells. You’d think it would’ve made some headlines when the FDA approved it in 1962, but I wasn’t paying any attention to such things back then. It’s all news to me now.
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