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#sunsafechallenge Winner Announcement!

Thank you to everyone who participated in our #sunsafechallenge instagram contest! Here are some of the awesome photos that were shared. Scroll to the bottom to see which post has been randomly selected to win a $100 Shoppers Drug Mart gift card!

      

And the winner is…

Congratulations, @ramonabietlot!

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February Conference Recap: Canadian Melanoma Conference and ASCO SITC

As February comes to a close, we’d like to look back on the conferences we attended this month: the Canadian Melanoma Conference and the American Society of Clinical Oncology (ASCO) meeting in Orlando, Florida!

Here is a sample of our social media from these conferences!

Canadian Melanoma Conference

 

ASCO Florida

 

 

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Merck and Pfizer Collaborate on Potential Merkel Cell Carcinoma Treatment

Merkel cell carcinoma (MCC) is a rare form of skin cancer, making up fewer than 1% of all non-melanoma skin cancers (Canadian Cancer Society, “Merkel Cell Carcinoma”). It manifests as malignant cells that form in the upper layer of skin, near the nerve endings that sense touch (Merck-Pfizer Alliance, “Merkel Cell Carcinoma Fact Sheet”). Merkel cell carcinoma often appears on sun-exposed areas of the skin, such as the legs, arms, neck, and head, as a blue or red lump on the skin. It most frequently occurs in fair-skinned males over 50 years of age (Merck-Pfizer Alliance).

Merkel cell carcinoma has a higher mortality rate than melanoma, with a mortality rate of 33% within five years of diagnosis (all stages) (Merck-Pfizer Alliance). Due to low awareness of merkel cell carcinoma, late diagnosis often results in the disease having reached stage III or IV(Merck-Pfizer Alliance).

Current treatment options for merkel cell carcinoma include chemotherapy, radiotherapy and surgery. These treatments are generally ineffective for advanced stage merkel cell carcinoma, resulting in a mortality rate of roughly 80% for stage IV metastatic merkel cell carcinoma patients (Merck-Pfizer Alliance). There is a gap in treatments for merkel cell carcinoma, and a need for more research and the staging of clinical trials to fill that gap.

Fortunately, at least one new treatment is in the works. JAVELIN merkel 200 is the title of an ongoing clinical study investigating the effects of avelumab, a treatment jointly manufactured by pharmaceutical developers Merck (Germany) and Pfizer (USA), on pre-treated patients with merkel cell carcinoma. The treatment inhibits PD-L1 interactions (Pharmaceutical Technology, “Merck and Pfizer’s Avelumab gets Breakthrough Status for Merkel Cell Carcinoma”), acting as an immune checkpoint inhibitor. The trial produced the largest set of data, in this patient population, of any anti-PD-L1/PD-1 (Pfizer, “ASCO 2016: Pivotal Avelumab Study Shows Positive Results in Metastatic Merkel Cell Carcinoma”). The results reported at the 52nd annual American Society of Clinical Oncology (ASCO) in Chicago this past June were promising: of 88 patients, 28 (31.8%) demonstrated an objective response rate during the Phase II study of avelumab (Pfizer). Of those that responded, 8 (9.1%) achieved complete responses, with 20 (22.7%) achieving partial responses (Pfizer). Of the entire trial, 62 (70.5%) patients experienced treatment related adverse effects (AEs), with the most common being fatigue (23.9% of patients) and infusion-related reactions (17%), with four patients (4.5%) experiencing grade 3 side effects and zero with grade 4 side effects (Pfizer). The ages of the trial participants ranged from 33-88 years old, and every participant had been pre-treated with chemotherapy (Pfizer). The patients received 10mg/kg of treatment intravenously every two weeks (Pfizer).

While avelumab is still in the trial stage, if it is approved, it will be the first approved treatment for Merkel Cell Carcinoma. Current information about the status of the trial can be found on the American clinical trial database or Pfizer’s website.

 
Works Cited:

Canadian Cancer Society, “Merkel Cell Carcinoma”.

Merck-Pfizer Alliance, “Merkel Cell Carcinoma Fact Sheet”.

Pfizer, “ASCO 2016: Pivotal Avelumab Study Shows Positive Results in Metastatic Merkel Cell Carcinoma”.

Pharmaceutical Technology, “Merck and Pfizer’s Avelumab gets Breakthrough Status for Merkel Cell Carcinoma”.

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Save Your Skin Weekly Flashback! [Sept 5-11]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! This week, we are excited to point you towards the most recent publication Save Your Skin has been involved in, CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease- A Call to Action,” in the Journal of the European Academy of Dermatology and Venereology! We’d also like to remind you of our next event, our “Mountain or Mole Hill?” skin cancer forum in Nanaimo, BC, on October 6th! Details can be found in the banner below.

 

PatientForumPoster_Oct2016

 

Here are some links we shared with you this week:

-A reminder to check out our “Melanoma Through my Lens” project, if you haven’t already!

This blog post by Doris Day, M.D., about the importance of sunscreens and choosing the right one for you

This Centers for Disease Control and Prevention guide to sun safety for children, which includes resources about sun safety for students

This article from the Canadian Cancer Society’s Research Information Outreach Team about the emergence of oncolytic virus therapy

This story in The Globe and Mail about Dr. Brian Day’s fight to lift the ban on paid-for private health care for “medically necessary” care

 

Thanks for reading, and be sure to stay sun safe even when the weather is cooling off!

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Diagnosis: Melanoma and Other Skin Cancers

There are several different routes to being diagnosed with melanoma. The first step is generally a physical screening, during which your physician will check your skin for moles or other abnormalities and ask questions, such as if there have been any changes in your skin or moles, or the length of time you have had certain moles. In order to accurately answer these questions, it helps to self-examine your skin monthly to keep track of any changes; more information on moles and skin self-examinations can be found here. During the appointment, your physician will likely also ask you about your medical history, if you have a history of getting sunburned or using tanning beds, whether there has been skin cancer in your family, and other similar inquiries.

If a physician finds something of concern on your skin, they may perform additional tests. These tests are outlined below in some detail:

Dermoscopy

Is the process of using a hand-held microscope, computer imaging or a dermatoscope to more closely examine a lesion. Your physician might apply mineral oil to the lesion to lessen light reflection on the skin.

Biopsy

Is a process in which cells or tissue of concern are removed from the body to be tested for cancer cells. Depending on the size and location of the lesion, either an incisional or excisional biopsy will be performed. An incisional biopsy is the removal of part of the lesion because the location or size of the lesion renders a complete removal impossible. An excisional biopsy is the removal of the entire lesion, plus a small margin of surrounding normal tissue.

Biopsies are also often performed on the lymph nodes surrounding the cancer site, given that cancerous fluid is likely to move through them. The closest lymph node(s) to the cancer site is the sentinel node(s). As the most likely place a cancer will first spread, the sentinel node(s) and sentinel node biopsies (SLNB) are important for melanoma staging and prognosis. SLNB is often used when clinical evidence that cancer has spread to other lymph nodes is lacking. SLNB will generally not be performed in cases where the patient has stage 1A melanoma, melanoma in situ, metastatic melanoma, locally advanced melanoma that has spread to a lymph node, or has already had surgery on a lymph node. Ideally, an SLNB will be performed at the same time as another surgery. If cancer cells are present in the sentinel lymph node, it is likely that some of the lymph node biopsy procedures outlined below will be performed. If no cancer cells are present, it is unlikely that cancer has spread to the lymph nodes.

There are several other forms of lymph node related biopsy. A surgical lymph node biopsy involves the surgical removal of lymph nodes to see if they contain cancer cells. This is usually preceded by a fine needle aspiration (FNA) biopsy, in which fluid from a lymph node is removed and tested. There is also the lymph node dissection, in which all of the lymph nodes surrounding the cancer site are removed. This surgery is usually performed if the cancer has metastasized to the lymph nodes.

Understanding your Pathology Report – WEBINAR RECORDING AVAILABLE:

To diagnose diseases such as cancer, a sample of tissue called a biopsy is taken from a patient and examined by a pathologist to determine if cancer is present. A pathologist will then examine specimens removed during surgery (resections) for conditions such as cancer, to determine whether the tumour is benign or cancerous, and if cancerous, the exact cell type, grade and stage of the tumour. The pathologist, who is a member of your medical team, writes the pathology report that your treating doctor uses to provide the best care for you as a patient. In this webinar, Dr. Alan Spatz provides insight on understanding your pathology report so that you can play an active role in your treatment. Click here to view the recording on youTubeWith Dr. Alan Spatz, MD  Director, Pathology Department, Jewish General Hospital & Professor, Pathology and Oncology, McGill University

During your treatments, you may receive other tests to determine whether your melanoma has metastasized to other places in the body. These include x-rays, ultrasounds, blood tests, CT scans, or MRIs.

Thank you for reading; we hope this post answers some of the questions you might have had about the diagnosis procedures for melanoma and other skin cancers. If you would like more information, you can look at one of our sources below. While methods of diagnosing skin cancer are relatively universal, be aware that not every website we source content from is Canadian.

Works Cited

About Melanoma: Signs and Symptoms of Melanoma”. NCCN Guidelines for Patients: Melanoma. 2014: National Comprehensive Cancer Network Foundation.

Diagnosing Melanoma”. Canadian Cancer Society.

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Save Your Skin Weekly Flashback [July 30th-August 5th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We’ve shared quite a few things with you this week, including this document overviewing public Federal, Provincial, and Territorial drug benefit programs across Canada, and two other reads we loved: this Huffington Post blog by our friend Natalie Richardson over at The Impatient Patient, and this excellent New York Times article that provides some human context to the general success of immunotherapy treatments. We also posted blogs on why you shouldn’t partake in the DIY sunscreen phenomenon, and an overview of what to look for when you self examine your skin for moles.

 

 

Here are some other links we shared with you this week:

This piece in the Chicago Tribune reporting that the U.S. Preventative Services Task Force has declined to recommend regular full-body screening for skin cancers

This 24/7 Wall St article about skin cancer occurrence by state, including a ranked list

This National Cancer Institute guide to moles!

This OncLive piece probing the complex nature of the melanoma genome

This article in the Vancouver Sun about the dire need for dermatologists in B.C.

This piece on Cut Your Cancer Risk debunking the mythical windburn!

This Steele & Drex interview with Meteorologist Claire Martin about her recent, rare melanoma diagnosis

This Immuno-Oncology News piece about the immunotherapy combo of ipilimumab and T-VEC and it’s success with advanced melanoma patients

This BioCanRX piece about Save Your Skin Founder Kathy Barnard’s presence at the 2016 Summit for Cancer Immunotherapy in Halifax

This American Association for Cancer Research piece in Science Daily about a Centre of Integrated Oncology study which suggests combining the immunotherapy treatment ipilimumab with local treatments can increase the survival rate of melanoma patients

This CBS New York story about immunotherapy combinations

 

 

Thanks for reading, stay sun safe out there!

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Moles and Skin Self-Examination

Moles are the most common indication of melanoma and other skin cancers; luckily, they can be kept track of with skin self-examinations. According to the National Cancer Institute, those with more than 50 common moles have an increased chance of developing melanoma (“Common Moles, Dysplastic Nevi, and Risk of Melanoma”), which is why it is important to self-examine your skin (and your loved one’s skin!) every month.

There are no hard and fast visual rules about which moles might and might not develop into melanoma, however there are some guidelines you can follow when self-examining your skin to judge if any of your moles should be checked out by a physician.

Firstly, there are two kinds of moles. Common moles are, as the name suggests, common and less likely to develop into skin cancer (even though instances of common moles developing into melanoma do occur). The other kind of mole, the dysplastic nevus (plural nevi), has an abnormal appearance in comparison to the common mole. While dysplastic nevi are more likely to develop into skin cancer than common moles are, dysplastic nevi are not a definite sign of skin cancer. However, it is important to pay particular attention to changes in dysplastic nevi during your self-examinations.

Check out our page Skin Check Guide for more information!

The National Cancer Institute recommends that you look for the following changes in both common moles and dysplastic nevi, and to see a physician if any one of them occurs:

  • The color changes
  • It gets smaller or bigger
  • It changes in shape, texture, or height
  • The skin on the surface becomes dry or scaly
  • It becomes hard or feels lumpy
  • It starts to itch
  • It bleeds or oozes

(“Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute)

In addition to these changes, there are some more obvious signs that a mole may be developing into melanoma. Be aware that there are several types of melanoma and skin cancer, which manifest in disparate ways; it is important to track all changes on your skin, even if they do not appear to be indicative of melanoma. A good rule to follow here is the ABCDE’s of early melanoma detection, which the National Cancer Institute identifies as the following:

  • Asymmetry. The shape of one half does not match the other half.
  • Border that is irregular. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
  • Color that is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
  • Diameter. There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than 6 millimeters wide (about 1/4 inch wide).
  • Evolving. The mole has changed over the past few weeks or months.

(“Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute)

 

Tips for an effective self-examination

Now that you have an idea of what to look for, it’s important to get the most out of your monthly self-examination as possible. Here are some tips for being as thorough as possible:

  • Use a full length and handheld mirror
  • Perform your self-examination in a well lit area
  • Have someone else check areas you can’t see
  • Write down and take photos of any new discoveries, such as changes or new moles; this will be helpful if you need to contact your physician
  • Remember to check often forgotten areas such as: fingernails and toenails, scalp (using a comb and/or blowdryer), the bottoms of feet and in between toes, ears, and underarms

Thank you for reading, and we hope this post encourages awareness and skin self-examinations! If you would like more information, look to one of our sources below. While the principles of self-examination are universal, be aware that not every website we source content from is Canadian.

 

Common Moles, Dysplastic Nevi, and Risk of Melanoma”. National Cancer Institute. 11.01.11.

How to Check your Skin for Skin Cancer”. National Cancer Institute. 09.16.11.

About Melanoma: Signs and Symptoms of Melanoma”. NCCN Guidelines for Patients: Melanoma. 2014: National Comprehensive Cancer Network Foundation.

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Save Your Skin Weekly Flashback! [July 9th-15th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We’ve been very prolific on social media this week, as you’ll see by the links below, and we posted a blog about regional melanoma statistics in Canada, which you can check out here. If you’re just discovering Save Your Skin, or you haven’t looked recently, be sure to drop in on our survivorship initiative I’m Living Proof– we’re working on translating all survivor stories into French!

 

 

Here are some links we shared with you this week:

This Medivizor article about the effects of stereotactic radiosurgery on brain metastasized melanoma

This article in The Brownsville Herald about Super Ray and the Sunbeatables- a sun safety curriculum being rolled out in six Texas primary school districts!

This article in EurekAlert about a study by the Melanoma Research Alliance and Brown University which found that pre-screening of patients for melanoma did not see an increase in dermatologist visits or surgical treatments

This article in High Times about the University of Canberra and Cann Pharmaceutical Australia’s efforts to develop medical-grade cannabis therapy to melanoma patients

The OHSU Dermatology War on Melanoma registration page

This article in The Skin Cancer Foundation Journal about keeping toddlers and babies sun safe

This piece from ABC 6 Action News in Philadelphia about melanoma development in adolescents

This eyelid melanoma case study in The New England Journal of Medicine

This Jama Dermatology review in which the partners of melanoma patients were trained in skin-examination and identifying potential new melanoma

This CBC News article about a gene variant that may cause redheads to have increased skin cancer risk

This New York Post guide to vetting the sunscreens you buy

pERC’s final recommendation for Cotellic and Zelboraf

This article in The Sydney Morning Herald about the increasing incidence of melanoma in Australia

This North Shore News piece about the Save Your Skin Foundation’s ten year anniversary and other achievements!

 

Thanks for reading, have a sun safe week!

 

sunsafety

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The Gender and Geography Statistics of Melanoma in Canada

Last week, we posted a broad overview of the past ten years in melanoma statistics, drawn from the Canadian Cancer Society’s documents Canadian Cancer Statistics 2014, Special Topic: Skin Cancers and 2015, Special Topic: Predictions of the Future Burden of Cancer in Canada. This week, we’re going to focus on more geographically specific statistics; what is the melanoma landscape in your province like?

If you read last week’s post, you’ll know that in Canada, males are generally more likely to be diagnosed with melanoma than females. Over the past 25 years, the age standardized incidence rate (ASIR) of melanoma in Canadian males increased on average 2% yearly, while the ASIR of females increased but 1.5%; however, this percentage has jumped to 2.5% over the past eight years for females, likely due to the advent of tanning salons (2014 79). Between 1993 and 2009, men have seen a lifetime risk increase of 0.8%, while the lifetime risk increase rose 0.7% for women (79). Mortality statistics indicate that the melanoma death rates among Canadian males and females are consistent with diagnosis rates; the age standardized mortality rates (ASMR) have risen 1.2% yearly for males, 0.4% for females.

The higher melanoma incidence rates among men are also generally consistent from province to province, with the exception of Saskatchewan, in which the ASIR in 2010 saw 9.5 melanoma cases in every 100,000 males and 11.3 in every 100,000 females (2014 93, “Table 7.1”).

MelanomaASIRprovinces

(2014 93, “Table 7.1 Annual Percent Change in Age-Standardized Incidence Rates (ASIR) for Melanoma of the Skin by Province and Sex, 1986-2010”)

The comparative incidence rate of melanoma in men is consistently higher in every province (except Saskatchewan), though, as indicated by the annual percent change being greater for Canadian females by 0.6% overall, melanoma rates among women are catching up. The greatest discrepancy between males and females is on Prince Edward Island, which has the highest provincial rate of melanoma in Canada for males (93, “Table 7.1”). The demographic with the lowest melanoma rate in Canada, as of 2010, was women in Newfoundland and Labrador (93, “Table 7.1”).

melanomaASMRprovinces

(2014 93, “Table 7.2 Annual Percent Change in Age-Standardized Mortality Rates (ASMR) for Melanoma of the Skin by Province and Sex, 1986-2009”)

 

Thankfully, the age-standardized mortality rates (ASMR) for Canadians are considerably lower than the ASIR. “Table 7.2” indicates that while Nova Scotia has the highest melanoma mortality rate among both males and females, the mortality rates for both men and women on Prince Edward Island in 2009 were too low to be recorded, though “Table 7.1” cites PEI as having the highest incidence rate among Canadian provinces for men, and the second highest for women (the highest being Ontario). The mortality rate among women in Newfoundland and Labrador is also too low to be recorded; the lowest recorded mortality rates for both men and women are in Manitoba. It is notable that Quebec, while having one of the lower incidence rates among the provinces for both men and women, has similar mortality rates.

The Canadian Cancer Society states that “variations of melanoma prevalence by province […] largely reflect population size differences and but also differences in rates of melanoma diagnosis and survival” (2014 85), which are important factors to keep in mind when considering the above data. Thank you for reading, and thank you to the Canadian Cancer Society and their document Canadian Cancer Statistics 2014, Special Topic: Skin Cancers for the statistics!

 

Works Cited:
Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2014). Canadian Cancer Statistics 2014. Web.

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Save Your Skin Weekly Flashback [July 2nd-8th]

Welcome to the Save Your Skin Foundation media flashback- your weekly guide to the melanoma landscape, and the activities of the Save Your Skin Foundation! We hope you had a fabulous and sun safe Canada Day long weekend. Thanks to the Toronto Blue Jays, Save Your Skin was able to donate tickets to the Peer Project and to the melanoma survivors featured in our campaign with the Melanoma Network of Canada, #notjustskincancer to a game, at which they also ran the #notjustskincancer campaign! A blog post by Natalie Richardson of The Impatient Patient about the day can be found here. Thanks Blue Jays!

Also this week, Save Your Skin Founder Kathy Barnard was on Roundhouse Radio’s Impact with Don Shafer segment alongside Mary-Jo Dionne and Dr. Joel Claveau, discussing the importance of using sunscreen! Give it a listen here.

If you’re looking to catch up on some reading, check out our recent blog posts “Understanding the Pan-Canadian Pharmaceutical Alliance (PCPA) and How it Affects Those Fighting Skin Cancer” and “Melanoma in Canada: A Short Review of the Past Ten Years”.

 

Here are some links we shared with you this week:

This CTV News Atlantic interview with Dr. Ira Mellman about immunotherapy

This article in Metro Vancouver (featuring Save Your Skin Founder Kathy Barnard!) about checking your loved ones’ moles for possible melanoma

This response by the Urban Public Health Network to Environmental and Radiation Health Services Directorate’s document Consultation- Tanning Guidelines (warning: graphic images from page three onwards)

This Medpage Today video featuring Dr. Omid Hamid on the promising trial treatment T-VEC

This blog post by Save Your Skin’s pal Natalie Richardson over at The Impatient Patient about her sponsorship of the Meaford Soap Box Derby

This Pacific Dermaesthetics piece about EltaMD suncare products

This Huffington Post article about natural sunscreens

This Science Explorer piece about the effects of chemotherapy on the body and mind

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