This is how you recognize melanoma in time

We know that sunbathing can be harmful and that sunscreen is a must. But how do you recognize the 'wrong spot' and what treatments are available if it's not an innocent freckle?

Annette (51 years old): “Twelve years ago my husband discovered a strange birthmark on my leg. I am covered in moles anyway, but this one was different, not round, but with cracks. A kind of flat wart that is itchy and dark in color. It went away the other day “Monday to the doctor, on Wednesday to the dermatologist, and on Friday I had surgery. Things were wrong. I had melanoma, the most dangerous form of skin cancer. The operation was the beginning of an intense period.”

Losses caused by fires

Skin cancer is the most common type of cancer. 82,800 people were diagnosed in 2021, and 921 died from it. Of these, 788 died of skin cancer. These are impressive numbers and will not decrease in the future, as Professor Dr. John Hanen fears. He is an internist and oncologist at the Anthony van Leeuwenhoek Cancer Hospital in Amsterdam and professor of translational immunotherapy at LUMC in Leiden. “The skin has to endure more stress these days because of the sun,” he says. “This is due to climate change, an increased desire to travel to sunny places and because people are living longer.” Ultraviolet rays from the sun or tanning bed are the main cause of skin cancer. “Adults who were burned often as children, sometimes with blisters and everything, are particularly at risk. Too much UV rays can alter the DNA in skin cells and can lead to skin cancer.”
It is known: the lighter your skin color, the greater the risk. Although Annette tans easily, she has relatively fair skin with many moles. “I would lie in the sun for days without thinking about how much damage it could cause.”

The sunbed is There is no substitute for sunbathing.
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Radiation is just as harmful as sunlight, and you burn just as quickly.
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It does not help maintain vitamin D levels.
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Many tanning beds emit only UV rays. As a result, the skin does not build up natural protection and the light causes skin aging and skin cancer.

Significant impact

One damage is not the same as the other and its severity varies depending on the type of skin cancer. It usually occurs in areas that have been exposed to a lot of sunlight, such as the face, back of the hand, and shoulders. In women, more often in the upper chest and lower legs, in men on the ears, nose and scalp if hair does not grow there (anymore).
Aside from the rare forms, there are approximately three types of skin cancer. Basal cell carcinoma is the most common, with about 60,000 new cases annually. This type is the least harmful, because it rarely spreads and is easy to treat. However, the impact can be significant. Treatment means cutting. But if there is not a large area in depth to properly remove the stain, a person may have to miss part of their nose or ear. Even with “moderate” basal cell carcinoma.
The less common but more aggressive form is squamous cell carcinoma. This often looks like a pale pink lump or rough spot that grows and is sometimes painful. “This type can destroy structures deep in the skin. It spreads relatively quickly and can come back after it is removed.
The third type of skin cancer is the most dangerous: melanoma. This is usually a variable (birth) sign with a jagged edge. Although this type is the least common, with about 8,000 cases being diagnosed in 2022, the consequences can be enormous. Even deadly. So it's no surprise that Annette was so shocked by the diagnosis. “My husband was in a panic, everyone came to help, friends cooked and helped look after the children, who were four and six years old. I was upset too, but I was especially happy because my children were too young to really understand what was happening.

What a crazy place…

Fifteen years ago, Martine, then in her early 60s, developed skin cancer. She was subsequently diagnosed with basal cell carcinoma twice more. In her case too, it was someone else who brought it to her attention. “It was warm, and I was wearing a T-shirt. My daughter was visiting and pointed out a 'special place' on my chest. It looked like a birthmark, but it was quite irregular in shape. My GP immediately referred me to a dermatologist. To my horror, it was a cancerous carcinoma “But fortunately it was in the early stages. They cut out the spot and after a few weeks they protectively removed the edges. When it was found to be 'clean' there was no reason to do a follow-up examination.”
However, Martine remained cautious, which was a good thing. A few years later she had a strange bump on her face: basal cell carcinoma. “I had surgery again, and that was successful too. But four years ago, the rough spot on my leg turned out to be basal cell carcinoma again. It went away after treatment with chemotherapy ointment, so overall I was lucky.”
Martine is red with white, freckled skin, and has been burned countless times in her life. Her vigilant daughter prevented the worst from happening. “Now I apply sunscreen or cover my skin with every ray of sunlight. The hospital also checks my body every year for any abnormal spots.

Learn about melanoma

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Go to your doctor right away if you have a mole that has one or more of the following characteristics, also known as the ABCDE rule.
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Asymmetry: One half of the spot has a different color or shape than the other half.
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Border: The spot has an irregular, jagged edge.
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Colour/colour: The spot changes color or has different colours.
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Diameter: Spot size larger than 5 mm.
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Development: itchy spot, bleeding or changes.
Brun: kwf.nl

• This way you protect yourself from sunlight and UV rays.
  • Use sunscreen with a high protection factor (SPF) regularly.
  • Get out of the sun regularly. Please note: UV rays also pass through umbrella or clothing.
  •Are you burned out? Stay out of the sun for a few days. This way the skin can recover.
  • Burns when you are young can cause skin cancer later. Therefore, apply sunscreen to children well and often.
  
  know more? avl.nl/huidkanker, kwf.nl, stichtingmelanoom.nl

Under the knife

Annette had her melanoma removed, the only treatment at the time. This is still the first thing you do if you have skin cancer. Turns out their cut edges aren't “clean”. For this reason, the lymph nodes, a type of lymph node located in the groin, were examined. Unfortunately, metastases were found. Annette: “Infected glands, but as a precaution, uninfected glands were also removed. These operations caused all kinds of complications, such as poor wound healing and painful infections.
She also developed lymphedema: when the affected glands were removed, fluid collected in her leg, causing it to swell. The chance of this happening is one percent, but it is a side effect with a significant impact that also occurs with breast cancer.

The number of deaths shows that not every skin cancer patient is helped by surgery. Fortunately, there are new treatment methods such as the (previous) use of immunotherapy. Simply put, this is an injectable treatment that stimulates your immune system, causing it to recognize and kill cancer cells. “Cancer cells are incredibly smart,” says internal medicine oncologist John Hanen, MD. “They bend back to make them invisible to immune cells that should be eliminating the cancer. Cancer cells become more visible with so-called immune checkpoint inhibitors. Then your immune cells can Eliminate it.
This treatment is available as a follow-up treatment for patients with metastases in the lymph nodes. But research shows a better and faster effect of immunotherapy if it is used before the tumor is removed. “The tumor usually shrinks, so the surgeon has to cut less.
The second advantage is that any micrometastases that are not visible to doctors and devices are also removed. This reduces the risk of the tumor coming back and increases the chance of survival. Moreover, this treatment only takes six weeks, while the follow-up treatment lasts for a year. This matter is being studied in skin cancer centers in the Netherlands. Once the results are known, we will have to wait for approval so that the treatment can be used sooner.

New development: TIL

For patients who do not benefit from surgery or immunotherapy, there is another promising development. Hanen is researching TIL therapy, as TIL stands for tumor-infiltrating lymphocyte, a type of immune cell. “There are TILs in the metastases, and we remove them. We multiply them in the laboratory into billions of cells and then put them back in.”
It is a difficult treatment for patients, as they must stay in the hospital for two and a half weeks and then receive chemotherapy and a so-called growth factor. Chemotherapy destroys the cells and thus creates space for those billions of immune cells. The growth factor ensures that immune cells stay alive longer.
Although patients say the treatment feels like they've been run over by a truck, the research results are remarkable, Hanen says. “Thanks to the army of immune cells, metastases decreased in fifty percent of patients. In twenty percent everything disappeared!” However, it is not possible to give this treatment to every skin cancer patient, just to be on the safe side. “Such a radical treatment is unnecessary, as many people will already benefit from removing the area. In addition, this is not possible, because each patient receives a personalized product. We work with their unique immune cells.
Hanen is proud that they were able to fund this research in collaboration with the government and that this treatment is now being paid for. “It is important that patients recover within six weeks and that many of them can then return to work.”

• Basal cell carcinoma
  60,000 people received it in 2022, and almost everyone was healed. Rarely self-seeds.
  Cause: Sun, tanning bed, or childhood X-rays.
• Squamous cell carcinoma
  14,873 people were infected with it in 2022. It can spread. Early detection and appropriate treatment are beneficial for recovery.
  Cause: the sun or after a chronic wound (burn).
• skin cancer
  Received by 8,045 people in 2022. This aggressive form spreads faster than other forms. It is usually a black-brown or multicolored birthmark that is itchy, painful, or ulcerated. The spot often bleeds easily and grows quickly.
  The reason: the sun.
• Rare forms of skin cancer
  387 people will develop another type of skin cancer in 2022.
  Brun: kwf.nl

look forward

Annette has recovered but still has lymphedema in her leg.
She must also always be careful not to get dandruff or wounds, because without lymph nodes the immune system in the leg is lower and the infection can develop faster and more seriously. “In addition, my body is under a magnifying glass twice a year. Dozens of suspicious sites were removed because they were a major cause of concern. Fortunately, they turned out to be harmless.” She is not afraid of new melanomas. “It is possible that a metastasis from that time could appear in another organ. That could be disastrous. But I have no influence on that. Although the doctor was gloomy at the time, my husband and I now look to the future with peace of mind.”
With thanks to Prof. Dr. John Hanen, Internal Oncologist at Anthony van Leeuwenhoek Amsterdam, and Professor of Translational Cancer Immunotherapy at LUMC.