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The push to improve prevention and screening has been very successful, Kobayashi said, both in and out of the military.
“We have been, as a society, very successful in diagnosing and treating melanoma early. There’s been an epidemic of melanoma in the world — not only an increase in risk of getting melanoma but an increase incident reporting of melanoma,” he said. “We’re diagnosing melanomas much earlier and at a [shallower] depth. These melanomas we find are very superficial, and if diagnosed early, we have a great chance of treating them.”
If caught early, surgical treatment has a 100% cure rate, Kobayashi said.
If caught too late, the treatment options become more difficult. Once the melanoma has metastasized to the lymph nodes and internal organs, it becomes necessary to surgically remove the lymph nodes and metastatic lesions. That procedure is followed by chemotherapy.
Air Force physicians also have the option of using two newly-approved medications designed to attack melanoma cells. The first, vemurafenib (marketed as Zelboraf), only works on patients whose cancer has a specific mutation, which accounts for about 60% of melanomas. In clinical trials, patients using the drug had an increased six-month survival rate.
Ipilimumab (marketed as Yervoy) has been on the market since 2011. Designed to help improve immune response to cancer cells, trials show the drug offers as much as a two-year increased survival rate.
“There are a lot more in the pipeline,” Kobayashi said. “But there are a lot of potential side effects that we have to monitor. We work closely with our oncology colleagues, who are the ones prescribing these.”
DoD has its own research program targeting melanoma. A new study at Lackland Air Force Base is trying to identify the expression of MHC Class 1 antigens on melanoma cells. MHC (major histocompatibility complex) is a conglomerate of genes that help the body recognize what belongs in the body and what does not. Previous research suggests that, if expression of MHC antigens are better understood, it could provide keys to new pharmaceutical treatments for cancers and similar diseases.
1. Armed Forces Health Surveillance Center (AFHSC). Incident diagnoses of cancers and cancer-related deaths, active component, U.S. Armed Forces, 2000-2011. MSMR. 2012 Jun;19(6):18-22. PubMed PMID: 22779436.
2. Zhou J, Enewold L, Zahm SH, Devesa SS, Anderson WF, Potter JF, McGlynn KA, Zhu K.United States Military Cancer Institute. Melanoma incidence rates among whites in the U.S. Military. Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):318-23. doi: 10.1158/1055-9965.EPI-10-0869. Epub 2010 Dec 8.
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