More than skin deep: the path from diagnosis to treatment for Canadians with melanoma

Promising increases in survival seen with new treatments

The Roman god Janus was two-faced. As the doorkeeper of the heavens, he could see in all directions at once without moving – a handy trick. It’s appropriate our first month of the year is named for him since it’s a month of both looking forward and backward.

Skin cancer is also two-faced. For some people diagnosed with this cancer, it is detected early and can be successfully treated by removing the growths on the skin.

But skin cancer also has another more challenging side. Some people experience a serious form of the disease, which includes melanoma. This type of skin cancer is less common but more dangerous because it is more likely to spread to other parts of the body if it is not caught and treated at an early stage.[1] Until recently, metastatic melanoma, the most advanced form, was a very difficult diagnosis with little hope of long-term survival.

Fortunately, great progress is being made in increasing the odds for Canadians diagnosed with this cancer. Kathy Barnard, founder and CEO of the Save Your Skin Foundation, knows this all too well. Her diagnosis with stage IV metastatic melanoma came in 2003 and by 2005 she was told she had just months to live. One of her sons learned of a clinical trial on a new type of medicine taking place in Alberta and she was accepted.[2]

That’s how she became one of the first Canadians successfully treated with immunotherapy, a new form of cancer treatment that stimulates the body’s own immune system to fight cancer cells. For over fifteen years, Kathy’s been able to help others with the disease through the foundation she started when her outlook was at its bleakest.

Immunotherapy has now joined surgery, chemotherapy, radiation and targeted therapy as options for treating metastatic melanoma.

Melanoma develops when melanocytes – which are the cells that give the skin its tan or brown color – start to grow out of control. It can develop anywhere on the body, in otherwise normal skin or in an existing mole that becomes cancerous, and in people with any skin tone. Signs of melanoma include a large brownish spot with darker speckles, a mole that changes colour or feel or bleeds, a small lesion with an irregular border or that itches or burns, or dark lesions on palms, soles, fingers toes or on different mucous membranes.[3]

Unfortunately, the COVID-19 pandemic has led to missed melanoma diagnoses because Canadians have not been going to skin-check appointments. The Melanoma Network of Canada recently launched a public awareness campaign to help find Canada’s “1,999 melanomas undiagnosed since the start of the COVID-19 pandemic.”[4]

This is why it is important now more than ever for people to take control of their health, and that includes checking their skin for any changes or abnormalities. “The chances of beating melanoma significantly increase if it is detected and treated early. So, I urge everyone to introduce a monthly skin self-exam into their routine. It could be a 10-minute habit that saves your life” stresses Annette Cyr, Chair of the Melanoma Network of Canada.

To help with this self-exam, people can use as a guide the “ABCDE’s of melanoma” (see here for more information on this resource). “If you detect any changes to your moles, you need to contact your doctor and get a referral to a dermatologist,” Annette adds.

The incidence of melanoma has also been increasing in Canada for the past several decades. A key risk factor is excessive exposure to ultraviolet (UV) radiation through sunlight, tanning beds and sun lamps. Lack of attention to sun safety behaviours, particularly in the past, has contributed to this increase.[5]

Oncologist Marcus Butler sees a better future for melanoma patients. “The good news is that even though we’re seeing more and more melanoma, we are decreasing the chance of dying from the disease by surveillance and catching it earlier, and by using the newer types of treatments when it is found,” said Dr. Butler. As Medical Oncology Site Lead for Melanoma/Skin Oncology at the Princess Margaret Cancer Centre in Toronto, Dr. Butler’s group performs a wide variety of studies to examine the impact of melanoma therapies.

We can’t go back and undo potential damage we did to our skin in the past that contributes to the development of melanoma. However, we can change our sun and ultraviolet light exposure habits now and into the future to help protect against skin cancer and also be alert to changes to our skin to help spot cancer at the earliest onset.

With prevention and new treatment options, the fight against melanoma is looking much brighter.

For more information on melanoma, visit the following websites:

[1] American Cancer Society, What Is Melanoma Skin Cancer? https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html

[2] Save Your Skin Foundation, Our Team, Kathleen Barnard, https://saveyourskin.ca/team-bios/

[3] Mayo Clinic, Skin Cancer, Melanoma Signs and Symptoms, https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605

[4] Melanoma Network of Canada, https://www.melanomanetwork.ca/general/national-melanoma-hunt-launched-to-find-the-1999-melanomas-missed-during-the-covid-pandemic/

[5] Canadian Cancer Society, Canadian Cancer Statistics 2019, Incidence over Time, p. 20

No content of this article is intended as medical advice. If you have questions about your health, consult a healthcare professional.

Developed by C.A.R.P./Zoomer with financial support from Merck Canada Inc.