Understanding Melanoma:

From Prevention to Cure

Primary Prevention–

A National Call to Action

31January 2015

Jeffrey E. Gershenwald, MD

Professor, Dept of Surgical Oncology

Professor, Dept of Cancer Biology

Medical Director, Melanoma & Skin Center

Co-Chair, Melanoma Cancer Genome Atlas Program

Chair, AJCC Melanoma Expert Panel

Melanoma: A Rapidly Growing Problem

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1950 1960 1970 1980 1990

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Incidence

Death

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1950-2000↑ 619% Incidence↑ 165% Mortality

While the rate of almost all major cancers is decreasing, the annual incidence of melanoma continues to rise ~3%/yr

The Challenge

• ≈ 80,000 individuals expected to be diagnosed with invasive melanoma in 2014

• Most aggressive form of skin cancer

• <5% of skin cancers diagnosed• >75% of skin cancer deaths (~9,000/year)

• Ranks second among all cancers in years of productive life lost

• Affected patients often young/otherwise healthy• 2nd most common cause of cancer in women 20-29yo

• Increasing mortality in men >50yo

• Cost of lost productivity estimated $3.5B/yr in US

1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757

The Challenge

• Early-stage disease – overall prognosis favorable, albeit heterogeneous

• Historical long-term survival for stage IV disease –very poor

1Linos et al., J Invest Dermatol. 2009;129:1666-1674; 2 American Cancer Society. Cancer Facts & Figures 2013; 3 Cust et al., Int J Cancer. 2011;128:2425-2435; 4 Boniol et al, BMJ. 2012;345:e4757

The Challenge

• UVR exposure from the sun and indoor tanning devices is a major independent risk factor for melanoma

• When controlling for multiple factors, tanning bed exposure <18 years old increased melanoma risk by 85%

• Half of U.S. children & adolescents ≥ 1 sunburns per year• 1 blistering sunburn in childhood 2X lifetime melanoma risk• ≥5 blistering sunburns between ages 15-20 years associated

with 80% increased risk of melanoma

1 Cust et al., Int J Cancer. 2011;128:2425-2435; 2 Boniol et al, BMJ. 2012;345:e4757; 3 Lazovich et

al., CEBP 2010;19:1557-1568; 4 Guy et al., JAMA Dermatol. 2014;150:501-511; 5Linos et al., J

Invest Dermatol. 2009;129:1666-1674; 6American Cancer Society. Cancer Facts & Figures 2014

Radiation exposures classified as Carcinogens by WHO/IARC

Lancet Oncology , August 2009

However….tanning facilities exceed number of Starbucks and McDonalds in >100 major US cities

Collaborative NIH/NCI/NHGRI effort to create a comprehensive collection of maps that chart genomic changes that occur in each type of cancer

Indoor Tanning Device Use Among US High School Students (N=14,590)

Guy GP Jr, et al. Prev Chronic Dis 2011;8(5):A116;

www.cdc.gov/pcd/issues/2011/sep/10_0261.htm

Frequency of Indoor Tanning Device Use Among US High School Students (N=2,026)

Guy GP Jr, et al. Prev Chronic Dis 2011;8(5):A116;

www.cdc.gov/pcd/issues/2011/sep/10_0261.htm

By age 17:

• > 35% of white females use tanning beds

• 62% of whom use them ≥ 10 times per year

• Nearly all salons denied the known risks of indoor tanning.

• 4 out of 5 salons falsely claimed that indoor tanning is beneficial to a young person’s health.

• Salons used many approaches to minimize the health risks of indoor tanning.

• Tanning salons fail to follow FDA recommendations on tanning frequency.

• Tanning salons target teenage girls in their advertisements.

Food and Drug Administration (FDA) proposal to reclassify ultraviolet (UV) lamps: May 2013

https://www.federalregister.gov/articles/2013/05/09/2013-10982/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to#h-14

FDA Classification of Medical Devices

Balk, Fisher, Geller. Pediatrics 2013;131;772

Proposal: Class I Class II

2012 Tanning Bed Prohibition

Under Age 18 Legislation Across U.S.

2013 Tanning Bed Prohibition

Under Age 18 Legislation Across U.S.

2014 Tanning Bed Prohibition

Under Age 18 Legislation Across U.S.

2014 Tanning Bed Prohibition

Legislation Across U.S.

MD Anderson has reached out directly to assist

efforts in CO, KS, SC, WA, IA, and MD

The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014

http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html

The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014

• Calls on partners in prevention from various sectors across the nation to address skin cancer as a major public health problem

• Goal: Increase awareness of skin cancer & call for actions to reduce the risk of skin cancer

• Road map

http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html

The Surgeon General’s Call to Action to Prevent Skin Cancer – July 2014

• Five strategic goals:

1) Increase Opportunities for Sun Protection in Outdoor

Settings

2) Provide Individuals with the Information They Need to

Make Informed, Healthy Choices About UV Exposure

3) Promote Policies that Advance the National Goal of

Preventing Skin Cancer

4) Reduce Harms from Indoor Tanning

5) Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer Prevention

http://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/index.html

Joint Position Statement on Indoor Tanning

• State and federal legislation to ban the use of indoor tanning by minors under 18,

• Educational efforts that effectively communicate the risks of indoor tanning to teens and their parents, and

• Counter-advertising to de-normalize the perceived ‘beauty’ of tanned skin.

Impending Announcement!

Joint Position Statement on Indoor TanningEndorsing Organizations – January 2015

The Melanoma Moon Shot:

A Comprehensive Plan to Reduce the

Incidence & Mortality of Melanoma

Jeffrey E. Gershenwald, MD

Michael A. Davies, MD, PhD

Melanoma Moon Shot Co-Leaders

Melanoma Moon Shot Team Roster

Jeffrey E. Gershenwald Lauren Haydu Catherine Roca

Michael Davies Zachary Cooper Charuta Kale

Mary Tripp Tiffany Calderone Payal Pandit Talati

Ellen Gritz Sheila Duncan Mandy Jo Euresti

Elizabeth Burton Paula Orban Sara Kanoff

Irma Wintle Chantale Bernatchez Elizabeth Winters

Jennifer Wargo Marie Forget Carmen Galvan

Rodabe Amaria Shruti Malu Ousswa Kudia

Victor Prieto Julie Gardner Andy Futreal

Michael Tetzlaff Silva Frankian Guilio Draetta

Jonathan Curry Emily Casey Lynda Chin

Veera Balandayuthapani Rhiannon Dodge James Allison

Francesco Stingo Elizabeth Sirman Pam Sharma

Patrick Hwu Kody Milburn Carlo Toniatti

Elizabeth Grimm Sakara Waller Tim Heffernan

Merrick Ross Christine Spencer Sam Hanash

Jeff Lee Kerri Fernandes Keith Perry

Ernie Hawk Brenna Matejka Gordon Mills

Mark Moreno Carla Werneke Kenna Shaw

Integrated Analysis and Targeting of Oncogenic Drivers and the Anti-Tumor

Immune Response

Michael A. Davies, MD, PhDAssociate Professor

Departments of Melanoma Medical Oncology and Systems Biology

Jeffrey E. Gershenwald, MDProfessor

Departments of Surgical Oncology and Cancer Biology

Primary Prevention of Melanoma Through UV Radiation Protection in Youth

Mary Tripp, PhDInstructor

Department of Behavioral Science

Ellen Gritz, PhDProfessor

Department of Behavioral Science

Increase ultraviolet radiation (UVR) protection, decrease

sun exposure, and decrease tanning behavior in youths

in order to reduce the incidence of melanoma

Support, facilitate and evaluate legislative activities

Maximize reach and impact of evidence-based interventions

Melanoma Prevention Flagship

Goals

Provide Individuals with the Information They Need to Make Informed, Healthy Choices About

UV Exposure

• Strategy 2A: Develop effective messages and interventions for specific audiences

• Strategy 2B: Support skin cancer prevention education in schools

• Current focus on child care and early learning centers, to teach children healthy sun protection behaviors from an early age curriculum, teacher training, parent education, technical assistance

1 Gritz, Tripp, et al., Health Educ Behav. 2007;34:562-77; 2 Gritz, Tripp, et al., Prev Med. 2005;41:357-66

Provide Individuals with the Information They Need to Make Informed, Healthy Choices About

UV Exposure, continued

• Current focus on collaboration with MDA’s Cancer Prevention & Control Platform (CP&CP) to disseminate pre-K-12 sun protection programs

• Strategy 2C: Integrate sun safety into workplace health education and promotion programs.• Engage corporate partnerships in collaboration with CP&CP

Promote Policies that Advance the National Goal of Preventing Skin Cancer, continued

• Strategy 3A: Support inclusion of sun protection in school policies, construction of school facilities, and school curricula

• Strategy 3C: Incorporate sun safety into workplace policies and safety trainings

Reduce Harms from Indoor Tanning

• Strategy 4B: Continue to develop, disseminate, and evaluate tailored messages to reduce indoor tanning among populations at high risk• Research to examine the effects of UV photography on UV

protection/exposure behavior

• Strategy 4C: Support organizational policies that discourage indoor tanning by adolescents and young adults• Discourage school-sponsored debit cards that pay for tanning services

• Strategy 4D: Enforce existing indoor tanning laws and consider adopting additional restrictions• Research to examine compliance with Texas SB 329

Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer

Prevention

• Strategy 5B: Evaluate the effect of interventions and policies on behavioral and health outcomes• Dissemination and implementation research on sun protection

intervention for child care and early learning centers• Research to examine the effects of UV photography on UV

protection/exposure behavior

• Plan and convene Prevention Summit at MDA

The Challenge of Melanoma - revisited

• Can we actually prevent some melanomas?

• YES!

Thank you