The ninth annual UNC Multidisciplinary Melanoma Conference brought more than 120 health care professionals from across the state on Thursday, February 12 to learn about the detection and treatment of melanoma.
The conference, led by course directors, David W. Ollila, MD, and Nancy E. Thomas MD, PhD, and held at the William and Ida Friday Center for Continuing Education, drew people from a range of health fields. Dr. Ollila, a member of UNC Lineberger Comprehensive Cancer Center, a professor of surgery at the UNC School of Medicine and co-director of the UNC Skin Cancer and Melanoma Program, said a No. 1 priority for the conference is to educate all levels of providers. It just so happens, he said, that this year’s conference is also happening during a time of exciting, recent advances in systemic therapy for melanoma patients.
“We’re now in an era where we have changing paradigms,” Ollila said. Seven new melanoma therapies have emerged since 2011, including some targeting mutations of a gene called BRAF and others that work to trigger the body’s own immune system to fight the disease.
The conference was highlighted by a presentation from Antoni Ribas, MD, PhD, a professor of medicine and surgery at the David Geffen School of Medicine at the University of California Los Angeles and director of the UCLA Jonsson Comprehensive Cancer Center Tumor Immunology Program, on research into a new type of immune modulating drugs. PD-1 inhibitors, the first two drugs were just FDA-approved last year, work by blocking a receptor to activate the body’ immune system against metastatic melanoma cells.
The U.S. Food and Drug Administration approved the PD-1 inhibitor pembrolizumab in September for treatment of patients with advanced or un-resectable melanoma and who are no longer responding to other drugs. Ribas was the lead investigator for a phase I clinical trial for the drug. Another PD-1 inhibitor, or nivolumab, was approved in December.
Ribas said PD-1 inhibitors are going to mean “remarkable advances” in treatment.
Thursday’s conference also included talks on outcomes for surgical treatment for stage IV cancer, melanoma prevention, as well as cancer-causing behaviors.
Dr. Puneet Jolly, MD, PhD, an assistant professor in the UNC School of Medicine Department of Dermatology, spoke on sunscreen and sun protective clothing in melanoma prevention. He described recent regulations that put emphasis on sunscreen protection against both ultraviolet A as well as ultraviolet B radiation.
Historically, there hasn’t been as strong of an emphasis on protection against UVA radiation in sunscreen products, he said, as SPF is a direct measure of protection against UVB radiation alone.
New sunscreen labeling regulations have been put in-place to indicate protection against both. In 2012, the FDA established a test to determine which sunscreens could be labeled “broad spectrum,” to indicate protection against UVA as well as UVA radiation.
“This is important because it is becoming increasingly clear that UVA radiation plays a big role in the development of melanoma in addition to UVB,” Jolly said. “It is also becoming more apparent that sun protective clothing may be an even better way to protect against these harmful rays than sunscreen,” he added.
Indoor tanning was the topic of a presentation by Seth Noar, a UNC Lineberger member and professor in the UNC School of Journalism and Mass Communication. He spoke on a 2014 study published in JAMA Dermatology that found that young women continue to use tanning beds, despite being aware of the health risks associated with indoor tanning. Of 706 university women surveyed, 45 percent indicated they had used tanning beds.
“The evidence is in: we know how bad this is, we know it’s a carcinogen, but we have a lot of work to do in getting the word out, not only to young women who do this behavior, but to parents,” Noar said.
Also at the conference, a presentation by Karyn Stitzenberg, MD, MPH, FACS, a UNC Lineberger member and assistant professor of surgery in the UNC School of Medicine Division of Surgical Oncology, focused on a more uncommon type of melanoma – gynecologic melanoma. Vulvar and vaginal melanomas represent less than 2 percent of all melanomas. Although uncommon, the mortality rate from these melanomas is very high because patients generally present with advanced disease. To improve early detection, more provider awareness and education is needed. She said any sign of pigmentation in the external female genital organs or in vaginal tissue should be biopsied.
The 10th annual UNC Multidisciplinary Conference is already in the planning stages for February 2016.