Ninety-year-old former President Jimmy Carter announced Thursday morning that he’s being treated for melanoma, and the cancer has been found in his brain and liver.
My reaction: “Melanoma? Isn’t that supposed to start with weird spots on your skin?”
I turned to Dr. Elizabeth Buchbinder, melanoma expert at Dana-Farber Cancer Institute. Our conversation, lightly edited:
So is our popular conception of melanoma — odd, mole-like things on sun-hit skin — not consonant with reality?
So often, when people think of skin cancer, they think of the more traditional basal cell, squamous cell, where you go in to the dermatologist, they cut it off, maybe you need to get a little bit of liquid nitrogen, or something else, but really, once they’ve done that, the risk in terms of it affecting your survival or anything else is very low. They’re really very controllable cancers.
Melanoma is kind of the exact opposite of that. It’s the real bad actor among the skin cancers, because melanoma likes to get into the blood and spread. It likes to go anywhere it wants in the body. Some of the places it likes to particularly go are the liver and the brain. It can also go into the lungs and other areas of the body. It’s kind of the ‘bad boy’ of the skin cancers; it’s definitely a bad actor in terms of cancers in general, but then also in terms of skin cancers as a group.
And you can have melanoma without ever having seen a spot?
First of all, melanomas predominantly arise on the skin and are most commonly associated with sun or UV exposure. However, they can arise in areas of the skin that never see the sun. They can also arise on other membranes that are not visible; for example, the inside of the mouth or the inside of the intestine. They can also arise within the eye.
“Melanoma treatment is so exciting right now. The real cutting-edge is basically using the immune system to fight the cancer itself.”
Dana-Farber Cancer Institute
Although most of them arise on skin that are seen, some melanomas may arise on the skin and never necessarily be detected. We have a fair rate of what’s called ‘unknown primary,’ where we never find that skin spot, and one of the thoughts is that that skin spot either has been attacked by the person’s own immune system and kind of gotten rid of, or that something else has happened; it’s been scraped off or itched, or who knows? It just never was found. So there’s some rate of that.
And so what is the cutting-edge of melanoma research and treatment now?
Melanoma treatment is so exciting right now. The real, real cutting-edge is basically using the immune system to fight the cancer itself. What we’ve known for a long time is that the immune system has a relationship with cancer, and sometimes can keep it from growing or prevent new cancers from forming, but often the cancer kind of overcomes that somehow. And what’s happened with new treatments and with new research and understanding of how the immune system works is we’ve been able to use medications to make the immune system attack the cancer. Continue reading