Dr. D. Scott Ernst, MD, FRCPC
bh IN BRIEF
Dr. Ernst speaks to the importance of early detection and prevention in dealing with an increasing incidence of skin cancer and melanoma in Canada. He refers to sun behaviour as being a key driver of this trend and notes that skin cancer and melanoma need not be feared if caught and treated early. He also refers to new treatments which are providing hope in even advanced cases.
Dr. D. Scott Ernst, MD, FRCPC
Head, Division of Medical Oncology, London Regional Cancer Program; Professor of Medicine, University of Western Ontario, London, ON
Dr. Ernst’s clinical interest has been genito-urinal malignancies and melanoma. His research has focused on new drug development and bone metastases. He has authored over 50 peer-reviewed articles and is founding co-chair for the Canadian Melanoma Conference.
1. Melanoma is said to be a cancer of the young. What is the difference between skin cancer and melanoma?
Melanoma is less common and develops throughout one’s life. It has a genetic predisposition and is most common in the Caucasian population originating from northern Europe. Those with fair skin or red hair have up to ten times greater risk. There are two other types of skin cancer – squamous and basal cell carcinomas. These are very common but less lethal and are typically found in an older population.
2. What are the signs and symptoms? What can to be done to minimize the risks?
There are only two ways to minimize the risks. The first is sun exposure as a youth – frequent sunburns are dangerous. Chronic exposure to the sun over time is also a major cause. To reduce the risk you must protect yourself. Melanoma and skin cancer are both very treatable but early detection is the key. Australia has been very successful in educating it’s population to be aware of their skin through the ABC’s which apply specifically to skin moles – Asymmetry, Border (irregular), Colour (variable within the lesion), Diameter (over 6mm), and Elevation. When any mole shows these features, it should to be looked at by a healthcare professional.
3. During your 20 years in practice, has the prevalence of melanoma and skin cancers been increasing or decreasing? To what to you attribute this trend?
Melanoma has definitely been increasing. Twenty years ago the lifetime risk was 1 in 250. Today it is 1 in 60. This is a result of a combination of increasing incidence and the fact that we are living longer. The greatest influence on the increasing incidence has been sun behaviour – many people still don’t see sun exposure as a bad thing. Fortunately, there is more awareness of the dangers and early detection is getting better. Even though the incidence is much higher, the deaths rates remain about the same as 20 years ago.
4. What are some of the current available treatments and how do these affect patients?
The mainstay of treatment continues to be surgery with early detection being the key. If caught early, there is minimal impact relating to lost productivity and time away from work. Today we can achieve cure rates of over 95% with melanoma. However, if not detected until advanced stages, the cure rate falls dramatically to 15-40%. If melanoma is in an advanced stage, or returns, the only other modality is drug treatment. Radiation doesn’t work for melanoma. Chemo and immunotherapy have been around for many years with variable success, rarely with any impact on long term outcomes. A new class of drug agents is providing new hope for those with advanced cases. These new agents target a specific gene mutation, present in about 50% of patients. This is identified through genetic testing, and treatment has achieved up to an 80% initial response rate.
5. How important is education in addressing the increasing prevalence of melanoma and skin cancer? Do you see a role for employers providing education on this topic in the workplace?
Education is absolutely pivotal. Melanomas are one of the most lethal cancers, but also one of the most preventable and treatable. We do not need to fear – we just need to be aware of the ABC’s of detection, and use the appropriate sun protection especially for people who work outdoors. Some excellent informational websites, including the Canadian Cancer Society – www.cancer.ca , and the Save Your Skin Foundation – www.saveyourskin.ca are available as resources for employers and the public. There`s also a YouTube video entitled "Dear 16-year-old me" which is a particularly poignant testament to the need for lifelong skin cancer awareness.