Skin Cancers — Causes and Treatment

The JID Milestone Series allows both experts and non-experts to delve into the broader context of diseases and their biology in a comprehensive fashion. Now, the Milestones series has a new posting on the biology and etiology of skin cancers.

There are wonderful time lines for understanding the effects of the immune response, viruses, DNA repair, and external agents in causing and modifying skin cancers. Copy the time lines with proper attribution for lectures to both scientists and the general public and for your grant applications. In addition to UV and papilloma viruses as causes, I especially appreciated considering coal tar-induced cancers under a larger rubric, fossil fuel products and skin cancer. A new wording for the disease that Percival Potts found affects the skin and especially the scrotal sac of chimney sweeps. While there are far fewer chimney sweeps today, large parts of the population have fossil fuel fragments in their daily ambient atmosphere. Signaling pathways are important in the etiology of some skin cancer and as importantly have led to new therapeutic modalities now in the clinic.

Dr Stuart Yuspa organized this milestone and is to be congratulated as are all the authors of each milestone. Please see his introduction to this series, reproduced below, and be sure to read the articles.

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INTRODUCTION TO THE MILESTONES IN CUTANEOUS MALIGNANCY

Every review of the modern history of cancer research that doesn’t involve black humors begins with skin. Much of the current cancer lexicon used casually when discussing human cancer pathogenesis is derived from studies of human or rodent skin. Furthermore, the three major cancer-causing environmental agents, ultraviolet light, fossil fuel combustion products, and papilloma viruses, were recognized by astute clinicians and experimental biologists because they produced skin tumors. In fact, were it not for clinical observations and experimental studies of skin, whole fields now considered intimately involved in cancer development and progression would have been delayed or unrecognized. Such is the case, for example, of inflammation and the importance of immune function. It is because these vital contributions of skin research advance cancer research that the Journal of Investigative Dermatology chose to make this a subject of its Milestones feature. The following sections will outline some of the pioneering skin research that led to our current understanding of cancer pathogenesis and the pathogenesis of other human diseases. Here we discuss the basic biology of chemically induced tumors on mouse skin that revealed the sequential multistage nature of cancer development now recognized for virtually all human epithelial cancers. The importance of DNA repair for cancer risk, the incredible story of sonic hedgehog signaling in basal cell carcinoma, the most common human cancer, now recognized more broadly in many other target organs, the widespread influence of inflammation with specific positive and negative contributions by each component of the immune system, and the expanding recognition of the viral etiology of multiple cancer types are presented. This feature is not designed to be a comprehensive review of each topic but rather to give the historical context in which key observations were made that opened doors and illuminated the path to enormous insights.

Stuart H. Yuspa, MD, Lead Author, Milestones in Cutaneous Malignancy

Controversy: A Dermatology TED Conference: A Lot in Storrs for You

by guest blogger Sancy Leachman, M.D., Ph.D., Oregon Health & Science University

 

This year’s Storrs Lectureship is undoubtedly one of the most unusual meetings I have ever attended.  I don’t want you to interpret “unusual” as a code word for “bad,” but you can interpret it as “unconventional.” The typical didactic format was abandoned in favor of short, TED-type presentations followed by abundant discussion. The lectureship is designed to reflect “Fran Storrs’ mission” in a “Fran Storrs’ way.” For those of you that know Fran, you’ll know what I mean by that. For those that don’t, suffice it to say that Fran doesn’t back away from controversy and doesn’t hesitate to tackle difficult problems, but she approaches them with humor (and a lot of laughter!). The conference was a spectacular embodiment of all those things – more than anything, we addressed the problem of deep thinking. As practitioners of medicine, we are confronted daily with complex problems that require action on our part, but we don’t have time to contemplate these complexities and consider options as thoroughly as possible, especially with the counsel of experts. At this year’s Storrs Lectureship, we all took the time to think deeply, to question thoroughly, to disagree with experts, and most of all, to seek the best answers for our patients, community, and society.

 

This year’s topic was “Melanoma Screening & Diagnostics: Do They Make a Difference?”  This topic was precipitated by the fact that skin cancer screening is not recommended by the U.S. Preventive Services Task Force, which limits coverage by the Affordable Care Act. Before we demand or mandate new screening and diagnostics technologies, it is CRITICAL that we know: Are they making a difference? But the data and answers are complex and incomplete. Experts were assembled to help tease out the key elements in real time and we were able to ask meaningful questions like:  “Should skin cancer screening be recommended by the USPSTF?”; “What evidence do we need to assure it is beneficial for patients and society?” “What are the legal implications of making this recommendation?” For example, if the USPSTF recommends screening and we fail to screen all patients, are we more vulnerable from a legal perspective?

 

Obviously, I can’t capture the conference in a blog (view it online), but I do have a few thoughts: Dermatologists need to participate as actively as possible in this controversy, because our specialty is going to be driven by it for years to come. We need to be careful what we ask for, because we just might get it. And we should never be distracted from the patients’ best interest by our own fear of litigation (though I will continue to manage my highest risk melanoma patients in collaboration with other providers!). So, signing off on this topic until next year – new topics for next year’s committee are welcome now!