Australian scientists have developed the world’s first blood test to detect melanoma in its early stages.

Early trials of the test involving 209 people showed it was capable of picking up early stage melanoma in 81.5% of cases.

The next step for the scientists from Edith Cowan University is to carry out clinical trials to validate their findings, with hopes the test could be commercially available in about three to five years.

Professor Mel Ziman, head of the Melanoma Research Group at the university, said the test has the potential to save thousands of lives.

It can help deliver a more accurate diagnosis of early-stage melanoma, which can be tricky to detect with the human eye, particularly if small.

“It’s critical that melanoma is diagnosed more accurately and early,” Ziman said. “So a blood test would help in that identification particularly at early stage melanoma, which is what is the most concerning and would be most beneficial for everybody if it was identified early.”

Melanoma is the fourth most common cancer in Australia and claims the lives of about 1,500 people each year. About 14,000 cases were diagnosed in 2017.

Doctors currently rely on checking a patient’s skin to see any changes in existing moles or spots before making a diagnosis.

The blood test works by detecting 10 combinations of protein autoantibodies produced by the body in response to melanoma.

Ziman said the next step is to improve the sensitivity of the test, carry out extensive clinical trials and test results against biopsies of suspected melanomas.

If the trials prove successful, a pharmaceutical company would need to come on board to make the test commercially available around the world.

The blood test has been cautiously welcomed by health experts. The CancerCouncil Australia chief executive, Sanchia Aranda, said while it was an interesting development, Australians needed to keep checking their skin.

“It’s important all Australians keep a close eye on their skin and see their doctor straight away if they notice anything unusual,” she said.

Professor of Dermatology at the University of Melbourne, Rodney Sinclair, said the test still wasn’t 100% accurate.

“The false positive and false negative rates of this test mean that the results will need to be interpreted with caution and, where practical, combined with a full skin check by a dermatologist,” he said.

https://www.theguardian.com/society/2018/jul/18/world-first-melanoma-blood-test-detects-early-stages-of-deadly-skin-cancer

Know your moles

Moles are clusters of pigment-containing cells (melanocytes) and are usually harmless. Melanomas – the least common, but most dangerous type of skin cancer – can arise in pre-existing moles. Things to look out for include rapid growth, a change in colour, shape or border, and a previously flat mole becoming raised. Bleeding, itching, scaling or ulceration, also warrant urgent medical attention. It is useful to know what is normal, too; new, harmless moles often appear up to the age of 25, they tend to fade with age but often get darker in pregnancy. Dermatologist Howard Stevens says melanomas can look like innocent moles (“a wolf in sheep’s clothing”), so if you notice a single large mole (greater than 6mm in diameter) that is growing or changing, ask to see a dermatologist.

Spotting the changes

If you have lots of moles, it can be hard to keep an eye on them. Programmes that monitor your moles (mole mapping) use computer-assisted technology to photograph, analyse and store images of your moles over regular intervals. But you can do it yourself by looking out for the ABCDE of moles; asymmetry, border irregularity, colour change, diameter increase and enlargement or elevation. 

Watch your ears and eyes

Take special care of areas of skin that are often exposed to sun, burn easily and don’t heal well – such as the tips of your ears and areas around the eyes. Basal cell cancers – the commonest and least destructive type of skin cancer – often arise near the eyes and sides of the nose. Squamous cell cancers – less common, but occasionally aggressive cancers – can arise on the tops of your ears and lips, often starting as a roughened patch that won’t heal. Melanomas can arise anywhere on the body, either in an existing mole or as a new raised nodule or spot that looks like a mole. 

Know your risk

Be UV-aware

Exposure to high levels of ultraviolet (UV) radiation from sunlight or sunbeds increases the risk of all types of skin cancer. UVA rays cause skin damage such as wrinkles and play a part in some skin cancers. UVB causes sunburn and direct damage to skin cells and increases the risk of most skin cancers. UV levels can be high even on cloudy days. Rays are strongest from 10am to 4pm, at high altitude and the nearer you are to the equator. The Met Office publishes a UV index forecast for 417 world cities, giving a level of risk from 1-11 and advising about suitable precautions. 

What are ‘suitable precautions’?

Look after babies and children; later development of skin cancer is linked to childhood sunburn. Babies should be kept out of direct sun and kids should never be allowed to burn. When the UV index is 1-2 (a typical UK winter day), no protection is needed; UV 3-7 means you should wear a shirt, sunscreen, a hat and sunglasses. For UV 8-11, the advice is to seek shade, stay indoors during midday hours and wear a shirt, hat, shades and sunscreen at all times when outside. A hot summer day in the UK may well reach 7 or even 8. 

What sort of sunscreen is best?

You need a broad spectrum (UVA/UVB) sunscreen with a sun-protection factor (SPF) of 30-plus if the UV index is above 3. For an adult, you need two tablespoons (about the amount you can fit in your palm) of sunscreen for your entire body, including ears, neck, face, hands and feet. Put it on while still indoors because it takes about 15 minutes to be absorbed into the skin and start doing its job. Reapply every two hours or immediately after swimming or heavy sweating. Use a lip balm SPF 15-plus to protect lips.

Summer holidays still mean one thing for many people; basting in the sun until their skin tingles. But though it may top up vitamin D levels, too much sun is undoubtedly a bad thing, especially if you have light skin. One in five of us will get skin cancer at some stage, and there are more cases of skin cancer than all the other cancers put together. Consultant dermatologist Howard Stevens of Skin Care Networksays the key messages are simple; avoid the sun between 11am and 3pm, cover up and use sunblock. “Look at your skin and examine your own back. If you see something that isn’t healing after three to four weeks or is growing, you need to seek medical advice.”

Most skin cancers are non-melanoma; 75% of those are basal cell carcinomas (BCC) related to sunburn, 20% the more serious squamous cell carcinomas (SCC) related to long-term sun exposure and 5% are rarer types. Melanomas are less common, but more dangerous. They are in fact being seen more often, and although survival rates have improved substantially, they still kill three or four in every 100,000 people in the UK.

Sunburn

My memory of childhood holidays is of days spent in the sun and nights spent radiating heat. Nowadays, we know better, although you still see seriously overcooked Brits on beaches around the world. Sunburn is an inflammatory reaction of the skin to overexposure to UV radiation. The short-term pain goes away on its own but it can cause irreversible skin damage and predisposes you to skin cancer and premature skin ageing.

Actinic keratosis (AK)

These are the crusty little patches that appear, particularly on middle-aged, fair-skinned men once their hair recedes and their scalps are exposed to the sun. They also appear on other exposed parts such as the ears, backs of hands and forearms. There is only a tiny chance that an AK will become cancerous (from 0.025-16% a year) but it’s hard to predict which will progress to a squamous cell carcinoma (SCC), so treatment is usually recommended. They can be frozen, burned, scooped off or treated with a range of creams containing drugs that destroy them. The treated areas can leave scars; a strong incentive to slap on a hat and sunblock before they start to develop.

Basal cell carcinoma (BCC)

A drug called vismodegib is a new treatment for advanced or spreading BCCs, while Mohs is surgical technique used to make sure the whole BCC is removed without cutting more tissue away than is necessary. Slices are removed and examined bit by bit under the microscope until it is all removed. Most BCCs can be cured, though they may recur. Only a tiny minority will spread to lymph glands and become fatal.

Squamous cell carcinoma (SCC)

UV radiation (both A and B) from the sun and sunbeds is the main cause of SCCs. They can look like sores, ulcers or crusted lumps on sun-exposed areas. They usually grow slowly over months or years so can be easy to miss until they get quite large or start bleeding. They may be confined to the outermost layer of the skin (Bowen’s disease) or penetrate into deeper layers of the skin (invasive). In 5% of cases, an SCC may spread to other organs (metastatic) and be fatal. This is more likely in people whose immune system is severely impaired. Smoking predisposes one to SCC of the lip. If you are over 40, white, have actinic keratosis, a previous SCC or an impaired immune system, it pays to be particularly careful. Treatment is usually by cutting them out, using the Mohs technique if available. The vitamin nicotinamide (vitamin B3) 500mg twice a day may offer some protection against a recurrence of BCC or SCC.

Melanoma

This is the most serious type of skin cancer, and is most common on parts of the body that get intense, short bursts of sun like the back in men and legs in women. Tanning beds and sun lamps have also been associated with melanomas. Advanced melanoma has a high death rate but the earlier you catch it, the better your chances of survival. Overall, 85% of those diagnosed will be alive 10 years later. A melanoma may look like a new mole or a change in an existing one. Normal moles are small (less than 6mm diameter), round or oval and have a clear edge. If a mole changes shape, size, colour, sensation (becomes itchy) or surface (starts crusting or bleeding), you should see your GP. Treatment depends on the stage of the disease; surgery to remove the melanoma is always necessary, followed by radiotherapy and chemotherapy in more advanced cases.

Drugs that boost the body’s immune reaction against the melanoma (such as interferon-alpha) are in use. Trials into a vaccine to make the body produce antibodies against the melanoma are underway. Monoconal antibodies can be produced that lock onto specific cancer cells: ipilimumab has been licensed for UK use since 2011 and is approved for use when advanced melanoma spreads or can’t be removed. Drugs that disrupt signals between cancer cells (eg vemurafenib) are also being trialled for advanced and inoperable cases.

https://www.theguardian.com/lifeandstyle/2015/aug/16/skin-cancer-how-to-avoid-it-danger-signs