“Cataracts affect more than 20.5 million Americans age 40 and older, and 6.1 million Americans have had cataract surgery. Prevalence of Age Related Macular Degeneration-AMD increases with age. For people age 80 and older, approximately 3 in 10 Americans have early AMD and 1 in 10 have late AMD.”
American Academy of Ophthalmology (https://www.aao.org/newsroom/eye-health-statistics)
Certain medications are well-known causes of cataracts, and some drugs can also accelerate their development. Steroid medications – whether pills, injections, or eye drops – are most frequently associated with cataract formation. If you are taking steroid medications to manage a long-term condition, it is important to note any visual changes and to have your ocular health managed by a qualified ophthalmologist. The medications that can cause cataracts include: Corticosteroids, Eye drops containing steroids, Glaucoma medications, Certain antipsychotics and antidepressants, Certain medications for autoimmune conditions, and Medication to control heart arrhythmia
You may not have any symptoms at first, when cataracts are mild. But as cataracts grow, they can cause changes in your vision. For example, you may notice that:
These symptoms can be a sign of other eye problems, too. Be sure to talk to your eye doctor if you have any of these problems.
Maintaining healthy eating habits can help to prevent cataracts in two ways. First, a good diet will control your weight, thus eliminating one of the significant risk factors. Second, increasing your antioxidant intake can also inhibit the oxidation process. In a 2013 Swedish, researchers observed 30,000 women over age 49, and found that those who consumed the highest amounts of antioxidants had a 13 percent lower chance of developing cataracts than those who consumed the least amounts.
To reduce your risk for cataracts, be sure to eat plenty of foods high in antioxidants.
Home treatment. Early on, you may be able to make small changes to manage your cataracts. You can do things like:
New glasses or contacts. A new prescription for eyeglasses or contact lenses can help you see better with cataracts early on.
Surgery. Your doctor might suggest surgery if your cataracts start getting in the way of everyday activities like reading, driving, or watching TV. During cataract surgery, the doctor removes the clouded lens and replaces it with a new, artificial lens (also called an intraocular lens, or IOL). This surgery is very safe, and 9 out of 10 people who get it can see better afterwards.
Talk about your options with your doctor. Most people don’t need to rush into surgery. Waiting to have surgery usually won’t harm your eyes or make surgery more difficult later. Remember these tips:
Scientists are studying what causes cataracts and how we can find them earlier and treat them better.
“June is Cataracts Awareness Month. As the year nears its midpoint, aging adults are advised to pause and learn more about a vision-worsening condition that occurs around age 40 when proteins in the eye lens begin to break down, clump and form a cloudy area over time. Cataracts affect 70 percent of adults by age 75, and recent CDC data* indicate more than 17% of adults above age 40 have a cataract in one or both eyes.
Risk factors linked to early development and quicker progression of cataracts include excessive sunlight exposure, smoking, and long-term use of steroid medication. Medical conditions linked to higher risk include diabetes, obesity, high blood pressure, and prior eye surgery or eye injuries. Aging adults should discuss their health behaviors and history with their eye specialist to evaluate risk for developing cataracts and other age-related eye diseases to prevent blindness.”
UNC school of medicine / school of medicine ophthalmology (https://www.med.unc.edu/ophth/2023/06/june-is-cataracts-awareness-month/)
A cataract is a cloudy area in the lens of your eye. Cataracts are very common as you get older. In fact, more than half of all Americans age 80 or older either have cataracts or have had surgery to get rid of cataracts.
At first, you may not notice that you have a cataract. But over time, cataracts can make your vision blurry, hazy, or less colorful. You may have trouble reading or doing other everyday activities.
1-Nuclear cataracts, which form in the lens’ nucleus, are the most common type of cataracts. Because opacity develops in the center of the lens, known as the central nucleus, nuclear cataracts interfere with a person’s ability to see objects in the distance. Usually the result of advancing age, nuclear cataracts can take years to develop and often give the nucleus a yellow tint.
2=Cortical cataracts begin at the outer rim of the lens and gradually work toward the central core. Thus, this type of cataract resembles spokes of a wheel. Patients with cortical cataracts often notice problems with glare, or a “halo” effect around lights. They may also experience a disruption of both near and distance vision.
3-Subcapsular cataracts progress the most rapidly. While nuclear cataracts take years to develop, subcapsular cataracts reach an advanced stage within a matter of months. Posterior subcapsular cataracts affect the back of the lens, causing glare and blurriness. This type of cataract is usually seen in patients who suffer from diabetes, extreme nearsightedness or retinitus pigmentosa, as well as among those who take steroid medication.
Obesity is most commonly linked to the development of posterior subcapsular cataracts. According to researchers at Harvard University, individuals with a BMI of 33 had at least a 30 percent greater likelihood of developing cataracts, compared to subjects with a BMI of 23 or below.
**Congenital cataracts exist and refer to cataracts that are present from birth, as well as to those that develop in early childhood. These cataracts can be nuclear, cortical, or subcapsular. Congenital cataracts may be linked to an infection contracted by the mother during pregnancy or to a genetic condition such as Fabry disease, Alport syndrome, or galactosemia. Because clear vision is essential to the development of the child’s eyes and brain, it is important to diagnose congenital cataracts as early as possible.
Most cataracts form as a result of advancing age. Other possible causes of cataracts include environmental factors and certain medications, such as antidepressants. If your medical history or lifestyle increases your risk of developing cataracts, it is important to have your eye health monitored regularly by a qualified ophthalmologist.
Age is the main reason cataracts form. According to the American Academy of Ophthalmology, the eye disease appears in over 22 million Americans over the age of 40. Over 50 percent of Americans over the age of 80 have cataracts. In fact, if we live long enough, nearly all of us will eventually develop this condition. Because the lens of the eye cannot shed old cells naturally, protein that accumulates on the lens gradually builds up over time, progressively obscuring vision by preventing light from reaching the retina.
According to the U.S. Environmental Protection Agency, long-term exposure to ultraviolet radiation, especially UVB rays, can cause changes in pigment that lead to the formation of cataracts. This is especially common in tropical climates, where high concentrations of UV exposure occur year-round. To protect the eyes from sun damage, it is important to wear sunglasses with a high level of UVA/UVB protection.
Injury or trauma to the eye increases a patient’s risk of developing cataracts. Individuals who have experienced inflammation in the eye, either post-operatively or as the result of another eye disease, are also more likely to eventually develop cataracts. For instance, iritis is an ocular condition that causes chronic inflammation inside the eye, and is commonly linked to early and rapid cataract formation.
Lifestyle habits such as smoking or consuming alcohol are often considered causes of cataracts.
Certain medications are well-known causes of cataracts, and some drugs can also accelerate their development. Steroid medications – whether pills, injections, or eye drops – are most frequently associated with cataract formation. If you are taking steroid medications to manage a long-term condition, it is important to note any visual changes and to have your ocular health managed by a qualified ophthalmologist.
When you’re young, the lens in your eye is clear. Around age 40, the proteins in t he lens of your eye start to break down and clump together. This clump makes a cloudy area on your lens — or a cataract. Over time, the cataract gets more severe and clouds more of the lens.
“Actinic Keratosis a rough, scaly patches of skin that are considered precancerous and are due to sun exposure. Prevention is to cut sun exposure and wear sunscreen. Treatments include performing cryosurgery (freezing with liquid nitrogen), cutting the keratoses away, burning them, putting 5-fluorouracil on them, and using photodynamic therapy (injecting into the bloodstream a chemical that collects in actinic keratoses and makes them more sensitive to destruction by a specialized form of light).
Keratoacanthoma this is a harmless, hard nodule that appears on the skin, most commonly on the face or arm of elderly people. The nodule may grow to up to 2 centimeters in diameter over about 8 weeks before gradually disappearing. However, the unsightly nodule is often surgically removed. The cause of keratoacanthoma is unknown, although exposure to sunlight appears to be a factor.”
Medicine Net (https://www.medicinenet.com/image-collection/actinic_keratosis_solar_keratosis_picture/picture.htm)
Actinic keratosis (AK) is a skin disorder that causes rough, scaly patches of skin. Another name for AK is solar keratosis. AK is a type of precancer, which means that if you don’t treat the condition, it could turn into cancer. Without treatment, AK can lead to a type of skin cancer called squamous cell carcinoma.
–UV exposure from the sun or indoor tanning.
-History of skin cancer in particular history of actinic keratosis.
-Fair skin: People with fair skin including lighter color hair or eyes have an increased risk.
Warning Signs can help with early detection and treatment this can be successfully removed without complications. Look out for any new, changing or unusual skin growths, so you can spot skin cancers like BCC when they are easiest to treat and cure.
An actinic keratosis sometimes disappears on its own but might return after more sun exposure. It’s hard to tell which actinic keratoses will develop into skin cancer, so they’re usually removed as a precaution.
If you have several actinic keratoses, your health care provider might prescribe a medicated cream or gel to remove them, such as fluorouracil (Carac, Efudex others), imiquimod (Aldara, Zyclara) or diclofenac. These products might cause inflamed skin, scaling or a burning sensation for a few weeks.
Many methods are used to remove actinic keratosis, including:
The term “Keratoacanthoma” (KA) was coined by Freudenthal in the year 1936. It was first described way back in 1889 by Hutchinson and was called molluscum sebaceum and self-limiting epithelioma. KA is benign, self-limiting squamo-proliferative lesion.
It shows male preponderance and most commonly arises on the sun-exposed parts predominantly face, neck forearms, hands and legs. Cutaneous lesions arise from hair follicles whereas mucosal lesions originate from ectopic sebaceous glands. This is a slow growing cancer of the skin that looks like a dome or crater. This is common; more than 200,000 cases per year in US. Regarding treatment from medical professional is advised. This condition often requires lab test or imaging. Keratoacanthoma last several months. It is common for ages 60 and older and is more common in males.
–UV exposure from the sun or indoor tanning.
-contact with chemical carcinogens, or cancer-causing chemicals
-Infection with some strains of a wart virus, such as papillomavirus
-History of skin cancer in particular history of Keratoacanthoma.
Warning Signs can help with early detection and treatment, this can be successfully removed without complications if caught early. Look out for any new, changing or unusual skin growths, so you can spot skin cancers like BCC when they are easiest to treat and cure.
If your medical professional suspects a keratoacanthoma, they will first want to establish the correct diagnosis by performing a biopsy. Than treatments could include the following:
Very rarely, keratoacanthomas are treated with medicine injected directly into the skin lesion (intralesional chemotherapy). In patients with more than one keratoacanthoma, the medical professional may suggest taking oral medication (ie, isotretinoin) to reduce their size and number.
Once the skin cancer has been removed, frequent follow-up appointments with a dermatologist or medical professional trained to examine the skin are essential to ensure that the keratoacanthoma has not returned and that no new skin cancer has developed elsewhere on your body. In addition, good sun protection habits (as noted in the Self-Care section) are vital to preventing further damage from UV light.
“Most of the cells on the skin’s surface are flat, scale-like squamous cells. Squamous cell carcinomas are the second most common type of skin cancer, accounting for about 20 percent of all diagnoses. These cancers also are slowing growing, but squamous cell carcinomas can spread to lymph nodes and even internal organs. Research indicates that the metastasis rate of squamous cell carcinoma of the skin is less than 10 percent within two years of diagnosis.
More than 150 years ago, a German scientist named Friedrich Merkel documented what he identified as tastzellen, German for “touch cells.” They would later be named Merkel cells. These cells are found below the epidermis, where they interact with nerve cells and help the skin feel light touch, textures and fine details.
Merkel cell carcinomas may appear as bumps or nodules—often red in color—on sun-exposed skin. This is a rare cancer, but it is often aggressive and may metastasize. About 2,000 to 3,000 cases of Merkel cell carcinoma are diagnosed in the United States every year, according to the American Cancer Society, and the numbers are on the rise. The disease is rarely diagnosed in patients under 50 years old and is mostly found in white men older than 70.”
Cancer Center/ City of Hope (https://www.cancercenter.com/community/blog/2023/10/skin-cells-merkel-basal-squamous#Q2)
Squamous cell carcinoma is the second most common form of skin cancer in the United States. It accounts for about 15 percent of all skin cancers. It is caused due to over production of skin cells. Squamous cell carcinoma of the skin is caused by DNA damage that leads to abnormal changes (mutations) in the squamous cells in the outermost layer of skin. This cancer is common (More than 200,000 cases per year in US). The majority of squamous cell skin cancers are easily and successfully treated with current therapies.
Knowing the causes, risk factors and warning signs can help you detect them early, when they are easiest to treat and cure.
–UV exposure from the sun or indoor tanning.
-History of skin cancer, including squamous cell carcinoma (SCC) or melanoma
– Age over 50: Most BCCs appear in people over age 50.
-Fair skin: People with fair skin have an increased risk.
Warning Signs can help with early detection and treatment this can be successfully removed without complications. Look out for any new, changing or unusual skin growths, so you can spot skin cancers like BCC when they are easiest to treat and cure.
If the skin cancer is small, not deep into the skin, called superficial, and has a low risk of spreading, less-invasive treatment choices include:
More-invasive treatments might be recommended for larger squamous cell carcinomas and those that go deeper into the skin. Options might include:
When squamous cell carcinoma spreads to other parts of the body, medicines might be recommended, including:
This is a type of skin cancer characterized by flesh-colored nodule that occurs on the face, head or neck. It begins in the cells at the base of the uppermost layer of the skin (epidermis). A normal Merkel cell is a cross between a nerve cell and an endocrine (or hormone-producing) cell located on or just below the skin in the underlying tissue, and functions predominantly as a touch receptor. Merkel cell carcinoma occurs when these cells begin to grow uncontrollably.
Merkel cell tumors typically arise on, but are not limited to, sun-exposed parts of the body such as the face and neck. Their shape and color are less distinctive than other skin cancers, and they can often appear as an innocent pink pearly nodule. As a result, it is usually only the speed with which they grow that attracts the attention of patients and their doctors.
With early detection and treatment, Merkel cell carcinoma can be well contained and even cured. Treatment becomes more difficult as the tumor grows and spreads, but aggressive therapy can still lead to high rates of survival.
Again, Warning Signs can help with early detection and treatment this can be successfully removed without complications. Look out for any new, changing or unusual skin growths, get yourself to the doctor immediately so you can spot skin cancers like BCC when they are easiest to treat and cure.
–UV exposure from the sun or indoor tanning.
-History of skin cancer, including squamous cell carcinoma (SCC) or melanoma
– Age over 50: Most BCCs appear in people over age 50.
-Fair skin: People with fair skin have an increased risk.
-Male gender: Men are more likely to develop Basal Cell Carcinoma.
-Merkel Cell Virus. Recently, researchers have linked a virus to many cases of Merkel cell carcinoma. However, it remains to be determined if the Merkel cell polyomarvirus causes the disease, and if it might help guide future treatment. If so, the virus could offer promising new targets for immunotherapy.
“Your skin has three layers that house your sweat and oil glands, hair follicles, melanocytes, and blood vessels.
Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.
There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.
Basal cell carcinoma is a type of skin cancer. Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.
Melanoma is a kind of skin cancer that starts in the melanocytes. Melanocytes are cells that make the pigment that gives skin its color. The pigment is called melanin.”
MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605)
The skin is the largest organ of your body. It acts as a barrier between invaders (pathogens) and your body. Skin forms a waterproof mechanical barrier. Microorganisms that live all over your skin can’t get through your skin unless it’s broken. The skin and mucous membranes act as a physical barrier preventing penetration by microbes. If the skin is cut then the blood produces a clot which seals the wound and prevents microbes from entering.
There are layers of skin and the first five layers form the epidermis, which is the outermost, thick layer of the skin and is listed above in the pictures. Notice in the second picture on the Rt. shows all blood vessels below epidermis.
All seven layers vary significantly in their anatomy and function.
It is made up of three main layers, the epidermis, dermis, and the hypodermis, all three varying significantly in their anatomy and function. The skin’s structure is made up of an intricate network which serves as many functions for the body’s initial barrier against pathogens, UV light, and chemicals, and mechanical injury. It also maintains body temperature and prevents water loss from the body.
Of all the organs in the human body, few take the pounding your skin does. Yes, your skin is an organ, your body’s largest, in fact, and among your most important, considering you cannot live without it.
Your skin is a biological marvel capable of performing remarkable functions every day. It protects your muscles and organs from outside threats. It endures bumps and bruises, cuts and scratches, the sun’s burning rays and the grime left by dirt and dust. It moves and stretches when you do and mostly bounces back to form when you’re still.
Even when your body is at rest, your skin is a bustle of cellular activity. Basal cells change shape as they move to the surface to replace dying squamous cells. Merkel cells help your nerves sense the touch of another. Melanocytes produce melanin, the skin-darkening pigment that protects your skin from the sun.
And like other organs, your skin may develop cancer.
Skin cancer is the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.
There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.
You can reduce your risk of skin cancer by limiting or avoiding exposure to ultraviolet (UV) radiation. Checking your skin for suspicious changes can help detect skin cancer at its earliest stages. Early detection of skin cancer gives you the greatest chance for successful skin cancer treatment.
Basal cell carcinoma (BCC) is the most common form of skin cancer and the most frequently occurring form of all cancers. In the U.S. alone, an estimated 3.6 million cases are diagnosed each year. BCCs arise from abnormal, uncontrolled growth of basal cells. Basal Cell Carcinoma grows slowly, most are curable and cause minimal damage when caught and treated early.
Knowing the causes, risk factors and warning signs can help you detect them early, when they are easiest to treat and cure.
–UV exposure from the sun or indoor tanning.
-History of skin cancer, including squamous cell carcinoma (SCC) or melanoma
– Age over 50: Most BCCs appear in people over age 50.
-Fair skin: People with fair skin have an increased risk.
-Male gender: Men are more likely to develop BCC.
-Chronic infections and skin inflammation from burns, scars and other conditions.
Warning Signs can help with early detection and treatment, almost all basal cell carcinomas (BCCs) can be successfully removed without complications. Look out for any new, changing or unusual skin growths, so you can spot skin cancers like BCC when they are easiest to treat and cure.
When detected early, most basal cell carcinomas (BCCs) can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.
If you’ve been diagnosed with a small or early BCC, a number of effective treatments can usually be performed on an outpatient basis, using a local anesthetic with minimal pain. Afterwards, most wounds can heal naturally, leaving minimal scarring.
Options include:
Melanoma is a type of cancer that usually begins in the skin. Specifically, it begins in cells called melanocytes. These are cells that produce melanin. Melanin is the pigment that gives skin, hair, and eyes their color.
Melanoma is among the most serious forms of skin cancer.
Melanoma is the deadliest type of skin cancer. It can be “in situ” which means that the cancer is confined to the top layer of skin, thus being highly curable. It can also be “malignant” which means that the cancer can spread to other parts of the body which significantly decreases the survivability rate. Melanoma in situ can grow to be malignant melanoma if not treated. The key to surviving melanoma is early detection, and especially before it becomes malignant. Melanoma caught in the early stages of its development is highly curable with a 97% survival rate.
-Ultraviolet light exposure
-Moles
-Fair skin, freckling, light hair
-Family history of melanoma
-Personal history of melanoma or skin cancers
-Having a weakened immune response
-Being older
-Being male
-Xeroderma pigmentosum (XP): This is a rare, inherited condition that affects skin cells’ ability to repair damage to their DNA. People with XP have a high risk of developing melanoma and other skin cancers when they are young, especially on sun-exposed areas of their skin.
Again warning signs can count help with early detection and treatment this can be successfully removed without complications. Look out for any new, changing or unusual skin growths, so you can spot skin cancers like BCC when they are easiest to treat and cure.
Stage I melanomas have grown into deeper layers of the skin, but they haven’t grown beyond the area where they started.
These cancers are typically treated by wide excision (surgery to remove the tumor as well as a margin of normal skin around it). The width of the margin depends on the thickness and location of the melanoma. Most often, no other treatment is needed.
Some doctors may recommend a sentinel lymph node biopsy (SLNB) to look for cancer in nearby lymph nodes, especially if the melanoma is stage IB or has other traits that make it more likely to have spread. You and your doctor should discuss this option.
If the SLNB does not find cancer cells in the lymph nodes, then no further treatment is needed, although close follow-up is still important.
If cancer cells are found on the SLNB (which changes the cancer stage to stage III – see below), a lymph node dissection (removal of all lymph nodes near the cancer) might be recommended. Another option might be to watch the lymph nodes closely by getting an imaging test such as ultrasound of the nodes every few months.
If the SLNB found cancer, adjuvant (additional) treatment with immune checkpoint inhibitors or targeted therapy drugs (if the melanoma has a BRAF gene mutation) might be recommended to try to lower the chance the melanoma will come back. Other drugs or perhaps vaccines might also be options as part of a clinical trial.
Wide excision (surgery to remove the melanoma and a margin of normal skin around it) is the standard treatment for these cancers. The width of the margin depends on the thickness and location of the melanoma.
Because the melanoma may have spread to nearby lymph nodes, many doctors recommend a sentinel lymph node biopsy (SLNB) as well. This is an option that you and your doctor should discuss.
If a SLNB is done and does not find cancer cells in the lymph nodes, then sometimes no further treatment is needed, but close follow-up is still important.
For certain stage II melanomas, the immune checkpoint inhibitor pembrolizumab (Keytruda) might be given after surgery to help reduce the risk of the cancer returning. Radiation therapy to the area might be another option, especially if the melanoma has features that make it more likely to come back.
If the SLNB finds that the sentinel node contains cancer cells (which changes the cancer stage to stage III – see below), then a lymph node dissection (where all the lymph nodes in that area are surgically removed) might be recommended. Another option might be to watch the lymph nodes closely with an imaging test such as ultrasound of the nodes every few months.
Whether or not the lymph nodes are removed, adjuvant (additional) treatment with immune checkpoint inhibitors or targeted therapy drugs (if the melanoma has a BRAF gene mutation) might be recommended to try to lower the chance the melanoma will come back. Other drugs or perhaps vaccines might also be options as well as part of a clinical trial.
Your doctor will discuss the best options with you depending on the details of your situation.
These cancers have spread to nearby areas in the skin or lymph vessels, or they have reached the nearby lymph nodes.
Surgical treatment for stage III melanoma usually requires wide excision of the primary tumor as in earlier stages, along with a lymph node dissection (where all the nearby lymph nodes are surgically removed).
After surgery, (additional) adjuvant treatment with immune checkpoint inhibitors or with targeted therapy drugs (for cancers with BRAF gene changes) may help lower the risk of the melanoma coming back. Other drugs or perhaps vaccines may also be recommended as part of a clinical trial to try to reduce the chance the melanoma will come back. Another option is to give radiation therapy to the areas where the lymph nodes were removed, especially if many of the nodes contain cancer.
If melanoma tumors are found in nearby lymph vessels in or just under the skin (known as in-transit tumors), they are removed, if possible. Other options might include injections of the T-VEC vaccine (Imlygic), interleukin-2 (IL-2), or Bacille Calmette-Guerin (BCG) vaccine directly into the melanoma; radiation therapy; or applying imiquimod cream. For melanomas on an arm or leg, another option might be isolated limb perfusion or isolated limb infusion (infusing just the limb with chemotherapy). Other possible treatments might include targeted therapy drugs (for melanomas with a BRAF or C-KIT gene change), immunotherapy, or chemotherapy.
Some stage III melanomas might be hard to cure with current treatments, so taking part in a clinical trial of newer treatments might be a good option.
Stage IV melanomas have already spread (metastasized) to other parts of the body, such as distant lymph nodes, areas of skin, or other organs.
Skin tumors or enlarged lymph nodes causing symptoms can often be removed by surgery or treated with radiation therapy.
If there are only a few metastases, surgery to remove them might sometimes be an option, depending on where they are and how likely they are to cause symptoms. Metastases that can’t be removed may be treated with radiation or with injections of the T-VEC vaccine (Imlygic) directly into the tumors. In either case, this is often followed by adjuvant treatment with medicines such as immunotherapy or targeted therapy drugs.
The treatment of widespread melanomas has changed in recent years as newer forms of immunotherapy and targeted drugs have been shown to be more effective than chemotherapy.
Immunotherapy drugs called checkpoint inhibitors are often the first treatment. These drugs can shrink tumors for long periods of time in some people. Options might include:
Combinations of checkpoint inhibitors seem to be more effective, although they’re also more likely to result in serious side effects, especially if they contain ipilimumab.
People who get any of these drugs need to be watched closely for serious side effects.
In about half of all melanomas, the cancer cells have BRAF gene changes. These melanomas often respond to treatment with targeted therapy drugs – typically a combination of a BRAF inhibitor and a MEK inhibitor. However, the immune checkpoint inhibitors mentioned above are often tried first, as this seems to be more likely to help for longer periods of time. Another option might be a combination of targeted drugs plus the immune checkpoint inhibitor atezolizumab (Tecentriq).
While immunotherapy is often used before targeted therapy, there might be situations where it makes sense to use targeted therapy first. For example, the targeted drugs are more likely to shrink tumors quickly, so they might be preferred in cases where this is important. In either case, if one type of treatment isn’t working, the other can be tried.
A small portion of melanomas have changes in the C-KIT gene. These melanomas might be helped by targeted drugs such as imatinib (Gleevec) and nilotinib (Tasigna), although these drugs often stop working eventually.
Rarely, melanomas might have changes in other genes such as NRAS, ROS1, ALK, or the NTRK genes, which can be treated with targeted drugs.
Immunotherapy using other medicines might be an option if immune checkpoint inhibitors or other treatments aren’t working. Options might include:
These treatments can cause serious side effects in some people, so they are usually given in the hospital.
Chemotherapy (chemo) can help some people with stage IV melanoma, but other treatments are usually tried first. Dacarbazine (DTIC) and temozolomide (Temodar) are the chemo drugs used most often, either by themselves or combined with other drugs. Even when chemo shrinks these cancers, the cancer usually starts growing again over time.
It’s important to carefully consider the possible benefits and side effects of any recommended treatment before starting it.
Because stage IV melanoma is often hard to cure with current treatments, people may want to think about taking part in a clinical trial. Many studies are now looking at new targeted drugs, immunotherapies, and combinations of different types of treatments. (See What’s New in Melanoma Skin Cancer Research?)
