Immunotherapy against melanoma continues to grow. In fact, a brand new combination has been added to the now consolidated administration of one or two immunotherapy drugs together, which has already changed the history of the disease – a “superimmunotherapy” – which he foresees using all three drugs at the same time.
The tris nivolumab, relatlimab and ipilimumab, all immune checkpoint inhibitors, capable of removing the “brakes” from the immune system against melanoma, brings the survival percentage of patients with advanced melanoma, followed for more than 4 years, to well 72%. More than 20% of what drugs administered alone or in pairs would do.
Opening up this new frontier of immunotherapy is the RELATIVITY-048 study, led by Paolo Ascierto, president of the Melanoma Foundation and director of the Melanoma Oncology, Oncological Immunotherapy and Innovative Therapies Unit of the Pascale Institute, conducted in collaboration with the universities of Zurich, Aix-Marseille, Lausanne, Oxford and The Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medicine. The research offers hope, even if it is preliminary data on inoperable patients who already have metastases. But once again, while waiting for improvement, experts reiterate the importance of prevention.
Why it is important to protect your skin
We would never dirty a business card by having to propose it to others. And then? So let’s pay more attention to our ticket. Which is nothing more than that Skin. Protecting it means safeguarding the integrity of the skin barrier by reducing the frequency of relapses of very frequent chronic inflammatory skin diseases, such as atopic dermatitis and contact dermatitis, and normalizing its microbiome, protecting us from infections.
And above all, it means protect our skin from the sun and UV rays means not only limiting photoaging and protecting yourself from the risk of developing melanoma, but also, above all, preventing non-melanoma skin tumors, such as basal cell and squamous cell carcinoma. To remind us of all this are the dermatologists of SIDeMaST, the Italian Society of Dermatology and Sexually Transmitted Diseases, at a conference in Giardini-Naxos. Their message is clear: “we need to raise awareness among people to protect and take care of their skin”.
How much does melanoma weigh?
Think about the incidence data for melanoma – in Italy the third most frequent cancer in both men and women under the age of 50 – detected in some Italian SIDeMaST dermatological centers: the first estimates indicate a double incidence – 30 cases per 100 thousand inhabitants – compared to official data which speak of 15 cases per 100 thousand inhabitants. In numbers, around 15 thousand new cases every year, compared to around 7 thousand estimated (ISS data).
“Today we have the possibility of better treating many dermatological diseases that previously, unfortunately, were difficult to cure, melanoma first and foremost – reports SIDeMaST president Giuseppe Argenziano, Professor of Dermatology at the L. Vanvitelli University of Campania in Naples – but the protection of one’s health starts first and you can’t win the game alone: you have to invest in your skin without ever letting your guard down.
Today we know perfectly well that 95% of epithelial malignant tumors and 70-95% of melanomas are caused from excessive sun exposure. Cancers that we can prevent by adopting an adequate lifestyle. This means understanding the importance of primary preventionprotecting themselves and their children from an early age from excessive and uncontrolled exposure to the sun, our ally in many respects but also a natural carcinogen, and to UV radiation in general, therefore not only that of the sun’s rays but also artificial radiation ”.
Watch out for warning signs
Protective measures in general include a combination that goes from seeking shade, protecting yourself with clothing, glasses and hats to using UVA and UVB protective creams with a high or extreme protection factor on uncovered areas. But be careful: prevention must continue by observing carefully any skin changeslearning to recognize the warning signs of the onset of skin cancer and consulting periodically with your dermatologist when you notice something different or growing.
“Despite the important results of the new therapies introduced for skin tumors – adds Maria Concetta Fargnoli, Vice President of SIDeMaST and Professor of Dermatology at the University of L’Aquila – early diagnosis remains our most important weapon and it is there that we must act, teaching people to constantly observe themselves carefully. The dermatologist today has numerous non-invasive diagnostic methods at his disposal which, in addition to the clinical examination, are very useful in improving diagnostic accuracy, allowing early diagnosis and avoiding unnecessary removals”. The card to play is precisely raise people’s awareness.
We focus on prevention since we were children
As often happens in medicine also for melanoma, in fact, prevention is better than cure. Because although this tumor is no longer as scary as in the past thanks to the availability of innovative drugs, first and foremost immunotherapy which is able to cure 50% of patients with metastatic disease, prevention and early diagnosis remain our best weapons. The later the diagnosis is reached, the more the disease progresses and the more complicated it becomes to treat it.
In any case, it is essential from a preventative perspective protect the skin from the sun’s rays: Sunburn during childhood or adolescence may increase your chances of developing melanoma in adult life.
According to the American Academy of Dermatology, five or more sunburns under age 20 increase the risk of melanoma by 80 percent and the risk of other types of skin cancer by 68 percent.
Sunscreens they are divided into two large groups: the ‘physical’ ones based on zinc oxide and titanium dioxide, which rarely cause irritation or skin hypersensitivity and act as a mechanical barrier. The latter can protect against both UVA and UVB rays and due to their characteristics they contain substances that can rarely irritate the skin causing contact dermatitis.
The risk of developing allergic reactions is even more real for children with atopic dermatitis, due to the lack of integrity of the skin barrier which exposes them more to external insults. However, the possible adverse effects of sunscreens in children are all treatable, manageable and above all very rare.
Be careful of sunburn
The sun is a bit like a drug. At the right doses it exerts the beneficial effects that lead us to be more serene, to have stronger bones, to counteract gloomy moods. But if you overdo it, especially in the first exposures, the risks far outweigh the benefits. Especially in people with very light skin, the risk of repeated burns and therefore to develop tumors grows. Melanin must be given the right time to “rise” towards the external layers of the skin, to build the bronze color which must then be maintained over time. Otherwise you only run risks.
Solar radiation in fact represents a real aggression: a physical insult, an irritating factor, against which the skin activates a series of response mechanisms modulated differently depending on the extent of exposure.
The skin response consists of the activation of defense mechanisms that involve the immune system, cellular self-repair systems, inflammatory mediators and melanin-producing cells. And there’s no need to rush. But above all, it is always necessary protect yourself adequately, in a targeted way based on the characteristics of the skin. Without overdoing the exposure.
“We all need to eat, but if we have a series of indigestions we pay for it in terms of health – points out the expert. The same happens with the sun. If we do not give the body the necessary time for the physiological production of melanin based on the stimulus, we risk sunburn and injuries which can then pave the way for much more serious problems.
Remember the checks at the dermatologist
There’s no need to rush. And there must be no “indigestion” of solar rays. You have to give time to the lower layers of your skin produce melanin and make sure that this rises towards the epidermis. Translated into practice: especially in the first hours/days of exposure, it is necessary to avoid being in the sun in the central hours of the day and to always protect yourself with adequate protection for the characteristics of your complexion.
Those who have particularly fair skin, eyes and hair should at least wear creams with protection 50 remembering to also protect yourself with a hat and t-shirt as soon as you feel that your skin is “tight”. The cream must be spread at least 15 minutes before exposing yourself to the sun, therefore not directly on the beach as soon as you change and above all it must be renewed every three hours.
Equally important is not to use residues of old creams, perhaps left in the beach bag. Don’t forget that these can degrade and therefore lose their protective efficacy. Unfortunately, tumors linked to the effects of ultraviolet radiation are on the increase, and prevention is the most effective weapon we have, together with early diagnosis. Which means we have to have regular check-ups at the dermatologist.
