Melissa Wilson, MD, PhD, is an assistant professor of medicine at NYU Langone’s Perlmutter Cancer Center, pursuing clinical and translational research projects focused on advancing treatment options for patients with melanoma. Dr. Wilson received her PhD in biochemistry and molecular biology from Georgetown University, attended medical school at Thomas Jefferson University, and completed her internal medicine residency and hematology and medical oncology fellowship at the University of Pennsylvania.
Transcript of Interview
Neal Howard: Welcome to Health Professional Radio. Glad that you could join us. I’m your host, Neal Howard and we’re going to have a conversation this morning with oncologist Dr. Melissa Wilson and she’s joining us today to talk about melanoma, the risk and some of the latest research and resources associated with it. Welcome to the program, Dr. Wilson.
Dr. Melissa Wilson: Hi. Thank you.
N: So, I mentioned that you’re an oncologist. Where are you practicing and talk a little bit about your normal patients?
M: Yes. So I practice at the Perlmutter Cancer Center at NYU Langone Health and I actually see patients with all types of skin cancers including basal cell, squamous cell and merkel cell carcinoma as well as melanoma. Melanoma is the majority of the practice of the patients that I see. I see patients who are just monitoring for recurrence, screening and surveillance patients as well as patients who have metastatic melanoma who are undergoing treatment.
N: Is everyone susceptible to melanoma? Are there certain factors that make some people more susceptible than others?
M: Well, certainly everybody has the potential of developing melanoma but there are certain characteristics that predispose certain patients to develop melanoma. One of them would be a family history of melanoma and some of these are tied to specific genetic changes and some of them are not. And then there are certain patients who have fairer skin to blonde hair, blue eyes, red hair, those characteristics seem to predispose patients to developing melanoma. Now, we certainly have patients who have other types of melanoma, mucosal melanomas and those are not some related but patients can develop that as well. And then certainly, the biggest predisposition to developing melanoma is UV exposure whether being natural sunlight or tanning beds.
N: In your experience, how many people would you say are dealing with melanoma that is a result of exposure to the sun?
M: About 90,000 patients per year.
N: Wow, every year. When it comes to cancer is it as serious as some of the others that we hear about more often?
M: Sure. Even with that number, melanoma is actually considered a rare cancer but it is increasing over time. So each year we see new cases and more cases and this is in the setting of where other known cancers are actually decreasing an incident, so melanoma continues to increase. While I had spoke earlier, while about 90,000 patients will develop melanoma in 2018 it’s only about 1% of those patients that will die from melanoma. It is a serious cancer and generally we feel that patients diagnosed with earlier stage have a higher risk of cure for their melanoma. But since 2011, we’ve seen remarkable treatment opportunities come up for patients and we are actually starting to see patients who are responding to the treatments that we have and have durable responses meaning the response lasts a long time and we have actually even had patients have complete responses meaning their melanoma goes completely away. This is new in the field of melanoma prior to 2011. The prognosis for disease that had spread to other sites or metastatic melanoma was pretty poor.
N: So being considered relatively rare but still very very serious, what would you say is one of the main factors that is causing this increase that you say since 2011, 2012?
M: It’s hard to really pinpoint what specifically has changed. Certainly there are a number of environmental factors that go into melanoma and increase on exposure is one of those environmental factors. People nowadays we travel a lot more than we used to, right? We’re going to a lot more sunnier areas than when we kind of didn’t really travel that much. We had the summertime when we were sun exposed and then wintertime when we didn’t. So that certainly can be a change. It’s like environmental as well as lifestyle. Certainly, we are seeing a lot more use of tanning beds and so that certainly is something to be taken into account when we see increased melanoma incidents as the use of tanning beds has changed. Then this is all on top of any underlying genetic factors.
N: Would you say that maybe age plays a role because as we age we become susceptible to so many other things that we weren’t necessarily a candidate for in our 20s and maybe even our 30s? Is that a factor or is it just anybody is susceptible?
M: Well, certainly age can play a role and we do see probably the average age of patients being diagnosed with melanoma is in about the 60s like from 63 to 65. However, we do feel that it’s exposure earlier in life that predisposes for the melanoma. So we’re very concerned about sun exposure and actually with sunburns, in patients when they’re in the puberty stage because the skin is very sensitive at that time and it’s possible that one bad sunburn in the puberty stage can actually predispose you for melanoma and development of melanoma later on in life.
N: You mentioned several promising treatment options that have become available. What would you say in your opinion is I guess the most exciting treatment option for melanoma?
M: So there are actually two. One is immunotherapy and the other is targeted therapy and these are the two areas where we’ve seen remarkable responses to treatment in patients. Immunotherapy takes the patient’s own immune system and turns it on to attack the melanoma cells. The newest development immunotherapy is what’s called checkpoint inhibitor. So the body has a way to turn the immune system on when it needs it. If you get sick, you get the flu, you get a cold or if you get a vaccination to make antibodies but then it has a way to turn the immune system off when you don’t need it because overactive immune system is what leads to autoimmune disorders and the simple way to describe it is that the way the body shuts the immune system off and it puts up some stop signs in the life cycle of white blood cells and specifically t-cells and it tells them “stop”. And so our new immunotherapies actually are antibodies that bind and block the stop signals. So essentially, you’re inhibiting the inhibitory signal, you’re revving up the body’s immune system to let the t-cells attack the melanoma. With targeted therapy sometimes in tumors we find genes that get broken and what happens when the gene is broken it makes a protein that is on all the time and that protein drives the cell, the melanoma cell to continue to grow and by using targeted therapy they’re generally pills that patients take, they can block those signals that are driving the cell and stop the cell from growing.
N: Let’s talk about some of the steps that folks can take to prevent melanoma.
M: Yes. We call them Safe Sun Practices so people don’t have to be hermit but they really should take care of themselves when they’re out in the sun. Sun protective clothing, hats, using sunscreen, using enough sunscreen, right? Sometimes we don’t put enough on, reapplying sunscreen if they’ve been sweating or in the pool or in the ocean or just in general after a certain period of time reapply sunscreen and to stay out of direct sunlight from between 10:00 and 4:00. There’s something that’s really one of the things that patients can do and they can teach
their children to do that because a lot of what we do as an adult is habit and what we did is when we were younger, so really teaching our children to do this as well and then really being
screened by a dermatologist yearly for mold checks, body check, skin checks to make sure there’s nothing, no mole or lesion that looks funny or changing.
N: Well, where can we go and learn some more?
M: The American Cancer Society has a website, www.cancer.org. There’s a Melanoma Research Foundation, www.melanoma.org and then the Melanoma Research Alliance, www.curemelanoma.org.
N:Dr. Wilson, thank you so much for joining us today on the program.
M: You’re welcome. Thank you for having me.
N: You’ve been listening to Health Professional Radio. I’m your host, Neal Howard. Transcripts and audio of the program are available at hpr.fm and healthprofessionalradio.com.au. You can also subscribe to this podcast on iTunes, you can listen in and download at SoundCloud and visit our affiliates page at hpr.fm and healthprofessionalradio.com.au.