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.

There are 3 types of Cataracts:

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.

Over 50 percent of Americans over the age of 80 have cataracts

RISK FACTORS:

1 Age

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.

2 History of Cataracts in the family

3 Ultraviolet Radiation (UVA or UVB)

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.

4 Trauma to the eye

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.

5 Have certain health problems, like diabetes

6 Smoking and Alcohol

Lifestyle habits such as smoking or consuming alcohol are often considered causes of cataracts.

7 Medications

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.

Most cataracts are caused by normal changes in your eyes as you get older.

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)

Continuation of Types of skin cancer:

5-Akinetic Keratosis:

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.

The risk factors of Keratocanthoma (KA):

“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)

Continuation of Types of Skin Cancer:

3-Squamous cell carcinoma – SCC

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.

The risk factors of SCC:

–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.

IT’S A FACT, Squamous cell carcinoma is considered more aggressive than basal cell carcinoma.  If squamous cell carcinoma does spread to internal organs it can be life threatening. The quicker the treatment when SCC is in the one layer of skin only the better the results.  The primary symptom to look out for with SCC is a growing bump or lesion on the skin which has a rough scaly surface or flat red patches.

Treatments for SCC:

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:

• Curettage and electrodessication. This treatment involves removing the top of the skin cancer with a scraping tool called a curet. Then an electric needle is used to sear the base of the cancer.
• Laser therapy. This treatment uses an intense beam of light to destroy growths. There’s usually little damage to nearby tissue. And there’s a reduced risk of bleeding, swelling and scarring.
• Freezing. This treatment, called cryosurgery, involves freezing cancer cells with liquid nitrogen. Freezing might be done after using a scraping tool, called a curet, to remove the surface of the skin cancer.
• Photodynamic therapy. During photodynamic therapy, a liquid medicine that makes the cancer cells sensitive to light is applied to the skin. Later, a light that destroys the skin cancer cells is shined on the area. This treatment might be used with surgery or other treatments.

Treatments for larger skin cancers:

More-invasive treatments might be recommended for larger squamous cell carcinomas and those that go deeper into the skin. Options might include:

• Simple excision. This involves cutting out the cancer and a margin of healthy skin around it. Sometimes more skin around the tumor is removed, called a wide excision.
• Mohs surgery. Mohs surgery involves removing the cancer layer by layer and looking at each layer under the microscope until no cancer cells are left. This allows the surgeon to remove the whole growth without taking too much of the healthy skin around it.
• Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. Radiation therapy is sometimes used after surgery when there is an increased risk that the cancer might return. It also might be an option for people who can’t have or don’t want surgery.

Treatments for skin cancer that spreads past the skin:

When squamous cell carcinoma spreads to other parts of the body, medicines might be recommended, including:

• Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. If squamous cell carcinoma spreads to the lymph nodes or other parts of the body, chemotherapy can be used alone or with other treatments, such as targeted therapy and radiation therapy.
• Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is usually used with chemotherapy.
• Immunotherapy. Immunotherapy is a treatment with medicine that helps the body’s immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.For squamous cell carcinoma of the skin, immunotherapy might be considered when the cancer is advanced and other treatments aren’t an option.

4-Merkel Cell Carcinoma

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.

Risk Factors of Merkel Cell Carcinoma:

–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.

-Chronic infections and skin inflammation from burns, scars and other conditions-weakens the immune system.

-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.

IT’S A FACT, Memorial Sloan Kettering Hospital in NYC states  “Merkel cell carcinoma, also called neuroendocrine cancer of the skin, is an aggressive type of skin cancer that affects only about 400 people in the United States each year. But like other skin cancers, that number is growing.”.

Treatments:

Treatment of stage I and stage II Merkel cell carcinoma:

“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)

  BASAL CELL CARCINONA

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:

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.

The first 2 types of skin cancer, which are:

1.Basal Cell Carcinoma  

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.

The risk factors of BCC are:

–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.

IT’S A FACT 90% of nonmelanoma skin cancers (mainly BCCs and SCCs) are associated with exposure to UV radiation from the sun.

Treatments for BCC:

2. Melanoma – worst cancer the deepest in skin  

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.

Risk Factors of Melanoma are:

-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.

IT’S A FACT Only 20-30% of melanomas are found in existing moles.  While 70-80% arise on normal-looking skin.

Treatments vary depending on the stage its in:

Stage I melanoma:

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.

Stage II melanoma:

This stage II skin melanoma have grown deeper into the skin than stage I melanomas, but they still haven’t grown beyond the area in the skin where they started.

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.

Stage III Melanoma:

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.

Treating stage IV melanoma:

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:

• Pembrolizumab (Keytruda) or nivolumab (Opdivo) alone
• Nivolumab combined with relatlimab (Opdualag)
• Nivolumab or pembrolizumab, plus ipilimumab (Yervoy)

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:

• Interleukin-2 (IL-2) (also known as aldesleukin)
• Lifileucel (Amtagvi), a type of tumor-infiltrating lymphocyte (TIL) therapy

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?)

“National data from this program reveal that about 1 in 3 women and 1 in 50 men respond “yes,” that they experienced MST, when screened by their VA provider. Although rates of MST are higher among women, because there are many more men than women in the military, there are actually significant numbers of women and men seen in VA who have experienced MST. In fact, over 1 of every 3 Veterans who tell a provider they experienced MST are men.

It is important to keep in mind that these data speak only to the rate of MST among Veterans who have chosen to seek VA health care; they cannot be used to make an estimate of the actual rates of sexual assault and harassment experiences among all individuals serving in the U.S. Military since all do not speak out.

Like other forms of trauma, MST can be a life-changing event. However, people are often remarkably resilient after experiencing MST. MST is an experience, not a diagnosis or a mental health condition, and there are a variety of reactions that Veterans can have in response to MST. Many individuals recover without professional help. Others may generally function well in their lives but continue to experience some level of difficulties or have strong reactions in certain situations. For some Veterans, the experience of MST may continue to affect their mental and physical health in significant ways, even many years later.

Recognizing that many survivors of sexual trauma do not disclose their experiences unless asked directly, VA health care providers ask every Veteran whether they experienced MST. This is an important way of making sure Veterans know about the services available to them.”

U.S. Dept of Veteran Affairs (https://www.ptsd.va.gov/understand/types/sexual_trauma_military.asp)

Many risk factors revolve around the nature of the traumatic event itself.

Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Women’s changing role in our military

A growing number of women are serving in the US military. In 2008, 11 of every 100 Veterans (or 11%) from the Afghanistan and Iraq military operations were women. These numbers are expected to keep rising. In fact, women are the fastest growing group of Veterans.

What stressers do women face in the military?

Here are some stressful things that women might have gone through while deployed:

-Combat Missions.

–Military Sexual Trauma (MST). A number of women (and men) who have served in the military experience MST. MST includes any sexual activity where you are involved against your will, such as insulting sexual comments, unwanted sexual advances, or even sexual assault.  Know this as well, how common it is?  An estimated 1 in 3 female veterans and 1 in 100 male veterans in the VA healthcare system report experiencing MST. It is important to note that by percentage women are at greater risk, but nearly 40% of veterans who disclose MST to VA are men.  A good question is how many just don’t report it period?

-Feeling Alone. In tough military missions, feeling that you are part of a group is important.

-Worrying About Family. It can be very hard for women with young children or elderly parents to be deployed for long periods of time. Service members are often given little notice. They may have to be away from home for a year or longer. Some women feel like they are “putting their lives on hold.”

Because of these stressors, many women who return from deployment have trouble moving back into civilian life. While in time most will adjust, a small number will go on to have more serious problems like PTSD.

How many women Veterans have PTSD?

Among women Veterans of the conflicts in Iraq and Afghanistan, almost 20 of every 100 (or 20%) have been diagnosed with PTSD. We also know the rates of PTSD in women Vietnam Veterans. An important study found that about 27 of every 100 female Vietnam Veterans (or 27%) suffered from PTSD sometime during their postwar lives. To compare, in men who served in Vietnam, about 31 of every 100 (or 31%) developed PTSD in their lifetime.

What helps? Research shows that high levels of social support after the war were important for those women Veterans.

What can you do to find help for women or men with PTSD?

If you are having a hard time dealing with your wartime memories, there are a number of things that you can do to help yourself. There are also ways you can seek help from others.

• Do things to feel strong and safe in other parts of your life, like exercising, eating well, and volunteering.
• Talk to a friend who has been through the war or other hard times. A good friend who understands and cares is often the best medicine.
• Join a support group. It can help to be a part of a group. Some groups focus on war memories. Others focus on the here and now. Still others focus on learning ways to relax.
• Talk to a professional. It may be helpful to talk to someone who is trained and experienced in dealing with aging and PTSD. There are proven, effective treatments for PTSD. Your doctor can refer you to a therapist. You can also find information on PTSD treatment within VA at: VA PTSD Treatment Programs.
• Tell your family and friends about LOSS and PTSD. It can be very helpful to talk to others as you try to place your long-ago wartime experiences into perspective. It may also be helpful for others to know what may be the source of your anger, nerves, sleep, or memory problems. Then they can provide more support.

Don’t be afraid to ask for help. Most of all, try not to feel bad or embarrassed to ask for help. Asking for help when you need it is a sign of wisdom and strength.

Don’t let PTSD get in the way of your life, hurt your relationships, or cause problems at work or school.

TYPES OF TREATMENT FOR BOTH MST including sexually harassed or assaulted and all other types of PTSD:

MST or PTSD treatment can help.  Learn what treatment is likely to help you make choices about what’s best for you.

If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past.

• Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.
• Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
• EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.

• Treatments for Veterans based on U.S. Dept of Veteran Affairs states the following;  “Evidence-based therapies are among the most effective treatments for PTSD. They can include the following — which are in many cases available at a local VA medical center.

  • Cognitive Processing Therapy (CPT) helps Veterans to identify how traumatic experiences have affected their thinking, to evaluate those thoughts, and to change them. Through CPT, Veterans may develop more healthy and balanced beliefs about themselves others, and the world.
  • Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
  • Prolonged Exposure (PE) helps Veterans to gradually approach and address traumatic memories, feelings, and situations. By confronting these challenges directly, Veterans may see PTSD symptoms begin to decrease.
  • Cognitive Behavioral Conjoint Therapy (CBCT) helps couples understand the effect of PTSD on relationships and can improve interpersonal communications. Veterans may also experience a change in thoughts and beliefs related to their PTSD and relationship challenges.
  • Eye Movement Desensitization and Reprocessing (EMDR) helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).”.

When looking for a therapist for post-traumatic stress disorder (PTSD), seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can start by asking your doctor if he or she can provide a referral to therapists with experience treating trauma. You may also want to ask other trauma survivors for recommendations, or call a local mental health clinic, psychiatric hospital, or counseling center.

“All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).

Examples of events that could cause PTSD include

• Physical, sexual, or emotional maltreatment
• Being a victim or witness to violence or crime
• Serious illness or death of a close family member or friend
• Natural or manmade disasters
• Severe car accidents.”

U.S. Centers for Disease Control and Prevention (https://www.cdc.gov/childrensmentalhealth/ptsd.html)