IN BRIEF - 7TH FEBRUARY 2018
Dr Ariel Haus, leading dermatologist and founder of Dr Haus Dermatology, on the evolution of skin cancer prevention and treatment
State of play
For me, the most important thing about where we are at the moment is a lack of understanding about the risks of skin cancer. I am seeing more and more patients with this problem—in fact, I would go as far as to say that we are in the grip of a skin cancer epidemic.
Skin cancer is caused by two forms of radiation generated by the sun: UVA and UVB. People generally associate UVA with ageing and UVB with skin cancers, but we now know that both types can induce cancer—they just have different methodologies. UVB can cause cancer directly by damaging the skin’s cellular DNA. UVA, which penetrates more deeply, seems to work by producing a high level of oxidants in the skin, which cause the cancer indirectly. Another recent development is our growing realisation of how air pollution can increase the risk of skin cancer.
There is a lot of work being done in the area of prevention, because everyone can take simple actions to reduce risk. First, use a good high factor skin block, even on cloudy days—especially if you are fair skinned. Also, through the latest research being published, we are realising that a good skincare regime using products with anti-oxidant properties is very effective. The sun block is a protective measure while the skin care regime has a more preventative role.
On the horizon
Here at the clinic we have something called mole mapping, which has the potential to be extremely exciting in the coming years. It is already one of the best ways to prevent and diagnose skin cancer, and it is likely to become ever more sophisticated.
The device uses a camera to take very detailed pictures of the mole or the lesion you are interested in. The machine’s software then examines the image and takes a whole series of very precise measurements of the target object and of any structural features within it. We can then track the object over time. If there are any small changes to the object—the size, colour, shape or a host of other factors—the software will flag up for the clinician to investigate further. At this point, we would look to take a biopsy. This is an excellent technology which is going to become more and more effective as we learn more about the growth of cancerous moles and lesions and can ask ever more pertinent questions.
In the distance
Researchers are in the process of developing biological therapies, which harness the power of the immune system to fight skin cancer. This can be done using monoclonal antibodies (MAbs), which are laboratory-produced antibodies that bind to specific antigens present on the surface of cancer cells, but are absent from—or present only at low levels—in normal cells. It is being made possible by advances in genetic engineering. Specific antibody cells can be programmed to attach themselves to a specific type of cancer cell, and then introduced into the patient via a series of injections. We use the immune system’s natural ability to identify and attack the cancer cells, but the body’s defences are augmented by the modified cells, which are much more effective at destroying the target cell than the immune system on its own.
It is still very early days for this treatment, and at the moment work with MAbs is confined to those with metastatic melanoma, also known as Stage IV melanoma, as the disease at this point is very serious. The great thing is that this is a way of targeting the cancer once it has spread to multiple sites.
This is a technology that has huge promise, not just for skin cancer but for dealing with other kinds of cancers as well. This is the new frontier of treatment—it is very exciting.