Melanoma can be found anywhere in the body and is often
more aggressive than other types of skin cancer. Coming up, Dr. Susana Ortiz from UCSF Medical Center in
San Francisco will discuss clinical trials that study genes to tailor treatment
for melanoma and other advances being made in melanoma treatment. It's all next on Patient Power.
Hello and welcome to Patient Power sponsored by UCSF
Medical Center. I'm Andrew
When you think about skin cancer, and skin cancer is quite common,
there are several types. The
scariest of all, quite frankly, is melanoma because melanoma can spread through
the lymph system to many places in the body, and unfortunately when it spreads
then it can be difficult to treat and can lead to death. So obviously you want to be avoiding
melanoma if you can, catching it early and having it surgically removed.
But the other part that we're learning now is there are different
subtypes of melanoma, and fortunately there are medications being developed to
target different subtypes and have more effective treatment. So that's good news if melanoma has
Explaining all that to us is a melanoma specialist from one of the
nation's leading research centers, of course, UCSF. That's Dr. Susana Ortiz, a dermatologist. She's an M.D., Ph.D. there. Dr. Ortiz, just to review, what is
Melanoma is, as you mentioned before, the deadliest type
of skin cancer and arises from transformed melanocytes. These are long?lived pigment?producing
cells that reside within the skin.
Melanocytes, as you mentioned before, are around the entire body, and
melanoma could get started anywhere in the body.
I understand sometimes it will show up as a mole or a
spot, but it can be of unusual shape, have different colors. And while we think of it often in
people who are fair skinned, red haired, with freckles, etc., it could be
Melanoma can arise any place in the body. The progenitors arise from the neural
crest, which is a part, a very important part during embryonic development, and
migrate into the epidermis all over the body, not only the skin but also
mucosal sites, for example oral mucosa or ob?gyn?related mucosal areas. Also for example the retina, this is
the pigment that we have on the posterior aspect of our eyes.
Wow. Well, of
course, at least as far as the skin that many of us can look at ourselves, it's
so important, I know, for people to get a check with a dermatologist pretty
regularly as you get older because obviously you want to eradicate this, treat
this, as early as possible. And in
melanoma that's particularly important, isn't it, Doctor, that if it can be
just one little spot that you can remove surgically and it hasn't spread
deeper, that's a good thing.
totally agree with you. It is very
important that everybody goes to a dermatologist at least once a year. We are very lucky in the sense that
melanoma is??evolves on the skin.
We are going to be able to see it.
We have in the clinic very important tools, not only our experienced
eyes. We have also special lights
called dermatoscopes that allow us to see the pigmentary pattern of moles that
are evolving to what we call a dysplastic nevus and then what would be the
beginning of a melanoma. By going
to a the dermatologist regularly as you would go to the dentist or to the
ophthalmologist, melanomas can be seen and discovered and treated earlier.
Now, unfortunately, it may not be observed. Someone may not have gotten a checkup, it just wasn't
caught, it was in one of those unusual places, and now it's spread. And I mentioned about the cells getting
in the lymph system and going somewhere else. Where might they go?
I think of the liver. Are
there other places as well?
Yes. Liver is
a common organ that is a target of melanoma cells. Also brain, lungs, a GI tract. To be honest, once it's in the lymph system melanoma cells
could go anywhere.
And then it's more difficult.
Then we start to talk about systemic therapy. So you've had different powerful drugs over the years that
try to fire big guns, if you will, at the melanoma cells wherever they've gone,
and I know it's been difficult. So
where are we now with what you'd call targeted therapies and also understanding
subtypes, genetic subtypes of melanoma, and how do you handle that at
Well, it's very important that we understand nowadays that
there are different kinds of melanoma.
As you mentioned before, there are subtypes. These subtypes are defined based on the status of key
melanoma genes and pathways or their combination. To explain this better, each subtype is defined by one key
oncogene. An oncogene is like a
driver that would tell the cell to divide with no restriction. How we handle these at UCSF, the first
thing we do is to try to analyze every melanoma by a genetic analysis. So we do what we call sequencing. We try to find, first of all, which is
the oncogene driving the melanoma.