What is melanoma?
Melanoma is a type of skin cancer originating from melanocytes, which produce melanin, the pigment responsible for skin coloration. Its primary cause is prolonged exposure to ultraviolet (UV) light, emitted by the sun or tanning beds. Limiting UV exposure is crucial in reducing melanoma risk, alongside regular sunscreen use. Other risk factors include age, family history of skin cancer, fair skin, light eyes, and numerous moles or freckles. Diagnosis typically occurs around age 66, with risk increasing with age. Darker skin tones generally have a lower risk, with a lifetime risk of 3% for whites, 0.1% for blacks, and 0.5% for Hispanics.
While melanomas can appear in any part of the body, they tend to occur more frequently in areas exposed to the sun.
Avoiding sun exposure, especially during peak hours from 11 am to 3 pm, using sunscreen with an SPF of 30 or higher, wearing protective clothing like long sleeves and pants, a wide-brimmed hat, and sunglasses, and refraining from using sunbeds are recommended strategies to minimize UV radiation exposure and lower the risk of melanoma. These measures are supported by scientific evidence and are widely advocated by healthcare professionals for sun protection.
Biopsy is a common and essential method for diagnosing melanoma. It involves removing a tissue sample from the body for lab analysis, enabling accurate diagnosis and treatment planning. One type of biopsy is excision biopsy, which is typically used in diagnosis, where the doctor cuts out the mole and some surrounding tissue for the specimen to be examined in a lab for cancer detection. On the other hand, in a punch biopsy, a circular blade is used to remove the suspicious mole.
Melanoma is classified into four stages, with stages 0 and 1 often more treatable due to the smaller size of the melanoma. However, treatment becomes increasingly challenging in stage 4 as the melanoma penetrates deeper into the skin and metastasizes to other organs such as the liver or lungs. If melanoma is detected, specialists first examine the melanoma’s thickness and depth under a microscope to determine the phase of the cancer. Imaging techniques such as MRI, CT, or PET may be used to determine whether the cancer has spread to other parts of the body.
Surgery is the primary treatment option for thinner melanomas. Nevertheless, if melanoma is more extensive and affects other parts of the body, treatment becomes more complex and customizable.
Treatment options for melanoma include surgery, radiation therapy, immunotherapy, targeted therapy, and chemotherapy, tailored based on the individual's condition and treatment goals.
First Personalized Melanoma Vaccine Development
The first personalized mRNA vaccine against melanoma is in development and undergoing Phase III trials in the UK, led by University College London Hospitals NHS Foundation Trust (UCLH). Utilizing technology similar to Pfizer-BioNTech and Moderna COVID vaccines, the trial involves 60-70 patients across 8 centers. Eligible participants must have had a melanoma surgically removed within the past 12 weeks for accurate results. Some patients receive a placebo, while others receive the vaccine. Patients can receive up to nine doses of the mRNA vaccine and up to 18 doses of Keytruda every three weeks for a year.
In the Phase II trial, it was discovered that vaccines significantly reduced cancer recurrence in melanoma patients. The vaccine aims to recognize and eliminate any remaining cancer cells in patients who have previously undergone melanoma treatment, thereby reducing the chance of cancer reoccurrence. In the Phase II trial, it was discovered that vaccines significantly reduced cancer recurrence in melanoma patients.
As Mr. Young, one of the participants, stated, "Scans showed I was radiologically clear; obviously, there is still the chance I had undetected cancer cells floating around. So rather than just wait and hope it never comes back, I actually had this chance to get involved in fighting it head-on." Hence, the vaccine targets to prevent comeback of the cancer, thus relieves the patients significantly. The personalized and customizable nature of the vaccine is also crucial in optimizing patient outcomes and the healing process, as it is designed specifically for each individual.
By matching the genetic signature of the patient's tumor, the vaccine directs proteins or antibodies to target the antigens, thereby stimulating an immune response against the tumors. Dr. Heather Shaw, an investigator for the trial at University College London Hospitals (UCLH), emphasizes that the vaccine is uniquely crafted for each patient, making it ineffective if administered to another individual due to its customized design.
Furthermore, Dr. Shaw noted that the vaccine is very promising as a "game-changer," considering its "relatively tolerable side effects," which include tiredness, arm pain, and in the worst-case scenario, flu-like symptoms for the majority of patients, not just for melanoma patients but also for other cancer types including lung, bladder, and kidney.
The phase III global trial will now include a broader range of patients, aiming to recruit nearly 1,100 people.
Given the global incidence of approximately 132,000 new melanoma cases annually and an upward trend, the personalized mRNA vaccine has the potential to positively impact numerous lives by offering effective treatment options.