Melanoma Facts With Dr. Yvonne Saenger

May is Melanoma Awareness month, a national campaign to increase awareness of skin cancer and shine a light on important information about melanoma, including prevention and treatments. We sat down with Yvonne Saenger, MD, a member of the Herbert Irving Comprehensive Cancer Center (HICCC), director of melanoma immunotherapy at Columbia University Irving Medical Center, and associate professor of medicine to learn about the disease, its risk factors and more. 

A pioneer in the space of cancer immunotherapy, Dr. Saenger focuses on the development of new clinical tools designed to bring the benefits of immunotherapy to larger patient populations, with an emphasis on patients with melanoma and pancreas cancer who do not respond to current available immunotherapies. Her work helps to identify biomarkers of immune response and advance immune-based therapies that have the promise to increase survival in cancer patients.

What is melanoma?

Melanoma is a cancer of the pigment cells of the skin. Ironically, it is the job of the pigment to protect people from damage induced by sun. When a person is exposed to sun the melanocytes will up regulate the production of melanin which absorbs the UV rays that protect the cells in their skin from DNA damage that could cause cancer. The problem is that when they produce the melanin—that process itself—releases free radicals and is oncogenic. Over time, the melanocytes themselves are at risk for producing tumors.

About half of melanomas will originate in a mole, and about half of them will form spontaneously, and they can form anywhere on the body, including in organs. We’ve spotted melanoma in the brain, in the eye, and in the gastrointestinal tract.

What are the risk factors of melanoma?

The risk factors of melanoma is about 50% sun exposure and 50% genetics. Red heads are  at higher risk for melanoma because the type of melanin they produce doesn’t work very well to  protect their skin. If someone has a family history of melanoma or if moles are prevalent, they should have a dermatologist that they see on a regular basis who can monitor any changes. People also should remember to use sunscreen on other less obvious areas of the body– for instance, our feet, the tops of our ears, or our scalps.

What are some early signs of melanoma?

The cardinal rule is to check to make sure that there are no changes on the skin. Anything on a person’s skin that doesn’t look the way it did last month should be checked by a dermatologist. It doesn’t mean it’s melanoma but it’s worth having a doctor take a look.

We do follow the A, B, C, Ds of identifying skin cancer. A stands for asymmetry--is one side of the mole shaped differently than the other half?; B for border—is the outline of the mole blurred or jagged; C equals color—if moles are very dark or appear multi-colored that could be a warning sign; and D for diameter, what’s the size of the mole and has it changed in size? The other aspect we take a look at is what we call the “ugly duckling” mole. If a person has a mole that really doesn’t look like any other mole on their body-- is very unique-- that could be an indication of a problem as well.

How is melanoma diagnosed?

Melanoma is diagnosed by a pathologist. The gold standard is a biopsy to determine whether it’s cancer.

Another way dermatologists can diagnose melanoma is actually via microscope. If the cells get damaged enough, the moles could become very dysmorphic and then we have something called a melanoma in situ which means it’s just sitting there at the normal spot but unfortunately the next step is melanoma itself because the melanoma cells will learn how to break through the barrier and eventually spread.

How is melanoma treated?

Treatment for melanoma is dependent on the stage of the melanoma. Something to bear in mind is that 5% of advanced melanomas are diagnosed without ever having a lesion on the skin.

Fortunately, the vast majority of melanomas are diagnosed at an early stage. Like other early-stage cancers the fundamental way to treat is surgical. A biopsy is performed to confirm it is melanoma and typically what happens then is that the doctor will go back and do a wider margin surgery.

Most guidelines would recommend systemic imaging after that point to make sure it hasn’t spread elsewhere.

The cornerstone for treating advanced melanoma is immunotherapy which is really very exciting. Immunotherapy is a therapy that targets a patient’s immune system and gets the immune system to fight against the cancer. Cancer survival, in general, has improved in this country primarily because of immunotherapy and that’s been particularly noticeable in melanoma. Fifteen years ago, advanced  melanoma was really one of the horrible cancers, with a survival rate of about 9 months. Immunotherapy has been one of the most wonderful changes that has happened recently in oncology – we now have immunotherapies that work.

What is a surprising fact about melanoma?

One interesting fact about melanoma is that people may not realize it’s actually the second cause of cancer death in young women after breast cancer. Women between the ages of 25 to 30 are being diagnosed with melanoma. Although melanoma is most common in the older population, of all cancers, melanoma is one of the more common ones in younger adults so be careful and stay out of the sun!