My Malignant Melanoma

Research at the University of Leicester will be breaking new ground in the search for a simple blood test that could tell whether a patient with melanoma has the condition in an aggressive form.

Melanoma is the most aggressive form of skin cancer. Staging, which involves determining the size of the tumour and its extent of spread, is the best predictor of whether a patient will succumb to disease or survive.

However, its predictive ability is relatively inaccurate, particularly for patients with melanomas that have invaded deeply into the skin.

A simple blood test that can be used alongside staging to improve the accuracy of outcome prediction would therefore be an extremely important development.

The project, led by histopathologist Dr Gerald Saldanha and Dr Howard Pringle, both in the University of Leicester Department of Cancer Studies and Molecular Medicine, aims to assess whether the measurement of a certain class of molecule called microRNA can identify patients who are more likely to have aggressive melanoma.

The study involves measuring over 600 microRNAs in the blood of patients with thick melanoma and analysing whether scientists can distinguish one set of melanoma patients in whom the disease has already begun to spread from another set for whom it has not.

If successful, this study would provide evidence that a blood test based on microRNA analysis could be further developed and used alongside staging.

This would enable more informed planning of treatment for patients who are found to be at greatest risk of poor outcome, while those at low risk could be reassured.

This research represents a new approach to the diagnosis and prognosis of melanoma.
Dr Saldanha, who is also an Honorary Consultant at University Hospitals of Leicester NHS Trust, explained: “I’m a skin pathologist and my job is to look down a microscope to diagnose melanomas and give prognostic information, in other words, the likely outcome for the patients. You tell that from the thickness of the melanoma from the top of the skin to the deepest point, and the deeper it is, the worse the outcome is likely to be.

“How good is that method at predicting outcomes? When the melanoma is very thin, less than 1mm, we’re good at predicting. We can tell that 95% of those patients will not have further disease five years after treatment.

“In the case of thicker melanomas we can only predict a 45%-75% five-year survival, which is little better than flicking a coin.

“In looking at the morphology of cells through the microscope we’re using methods that were used 150 years ago. It is an integration of everything that’s going on at the level of DNA and protein. There’s no molecular test that can match that at the moment.

“However, there’s a gap in our knowledge regarding the diagnosis of a minority of patients and a gap in the prediction of outcome for quite a significant number of patients. This project should add value to what I do by trying to plug the gap in predicting outcome.

“If you can combine the thickness of the melanoma with the microRNAs and tell that a patient has non-aggressive melanoma, you can reassure the patient and maybe avoid toxic chemotherapy or other drugs. But you’ve got to be very sure of your tests, of course, if you’re going to deny the patient the therapies.”

Thin melanomas are generally easily removable by surgery. Thick melanomas, once they begin to spread, may have a survival rate of as little as10 months. Gram for gram, Dr Saldanha says, melanoma is probably one of the most aggressive cancers. Chemotherapy has limited use, while other therapies based on modulating the immune system have had only a minority of lasting successes.

The new study is a collaboration between Dr Saldanha, who is a histopathologist, clinician and scientist; oncologist Steve Nicholson, who will be helping to take the blood from patients and documenting outcomes and Dr Howard Pringle, who is the molecular scientist of the group.

To eliminate ‘false positives’ (false leads) Dr Saldanha will also be working with bioinformatics expert at Nottingham Trent University, Graham Ball, hopefully ensuring that only important microRNAs are identified.

The project has received funding from the Leicestershire and Rutland charity Hope Against Cancer, in the form of a Rod Cassady Fellowship, which will enable Dr Saldanha to take on a researcher dedicated to the study.

He said: “This work certainly wouldn’t be getting under way without HOPE. This is a new project for us and the funding means I can tackle the research properly and thoroughly from the word go.

“Hopefully, it will pump prime the next stage, too, when we will need to find an independent group of patients to validate the microRNAs we’ve found. If we can reproduce the findings in a brand new data set that will be very important. This is the first step.”

While moles are harmless and very common, melanomas are rarer. Skin contains melanocytes which make pigment and sometimes these can form tumours, which may be aggressive and spread.

Melanomas are, Dr Saldanha says, in the second tier of cancers. Nationwide, doctors see about 10,000 cases a year, compared with 40,000 cases each for prostate, breast, lung and colorectal cancers.

However, the number of melanomas has increased 3-4 fold over the past 20-30 years and by a staggering 60% over the past decade, more than any other cancer, Dr Saldanha says.

“Melanoma is interesting because it’s very aggressive and it has this odd pattern of increasing incidence that we haven’t got to the bottom of. The biggest increases are in countries where fair-skinned people are exposed to the sun, like Australia, New Zealand and the US, but UV damage and skin cancer isn’t a simple story. It isn’t as straightforward as lung cancer, for instance, where the more you smoke the more likely you are to get lung cancer.

“It seems to involve sunburn in younger people. It’s one of the few solid cancers that is common in young people and is the commonest solid cancer in the15-34 age group. There’s some conflict as to whether it’s still on the increase or not.”

A new large study has found NO association between Vitamin D intake and Melanoma incidence after correcting for known risk factors, contrary to what you might have heard elsewhere.

And just to illustrate how things can work in the lab which do not necessarily do so in people, paracetamol has high anti-tumour activity in lab mice artificially inoculated with human melanoma cells.

There has been some speculation recently as to whether the one of What Now admins is in fact Mr Wilson from Home Improvement. Nope.

"Mr Wilson" was Earl Hindman, seen below. James can't be Earl, as Earl died of lung cancer in 2003 at the age of 61, and James is about twelve and has never had cancer.












James is shown unobscured below, you can see there is little resemblance once he is no longer assuming the "Chad" pose.










James

Steve has also submitted his story of stage 4 melanoma survival to us today. Steve is having a holiday at present between clinical trials, and has recommended MIA for travel insurance, as many other cancer patients have to me.

I just haven't bothered to go through the added hassle of getting a letter from my doc. confirming I'm safe to travel, and giving them a very detailed medical history over the phone. I hear they call you back for that bit though.

Thanks for your story and the tip, Steve.

New melanoma story. Thanks Julie. Hope things go better than you fear.

Just back from Katie's midnight walk. There was a good turnout, and over £4,000 was raised for Notts Uni Hospital Melanoma Research, in addition to the better than £1,000 raised on the justgiving site. The cheque for the money raised will be presented to Prof. Patel from NUH on the 24th June.

There is to be a "Friends of Katie" Fund established, raising awareness and funds between the annual walks. If you contact me at help@mymalignantmelanoma.com, I can pass on your details.

I had a question a little while ago about how reliable the information on diet and lifestyle in Barry Groves' book "Trick and Treat" was, after it had been publicised on a cancer site.

The book makes some claims which fly in the face of the scientific evidence. In support of its extraordinary claims, it offers no new research or other scientific evidence, but instead represents merely a reinterpretation of the available evidence by someone with no relevant qualifications.

No relevant qualifications you say? But Groves says he has a doctorate!

His "doctorate" was apparently purchased from Trinity College and University, an internet diploma mill. If you'd like to call yourself "Doctor" as well, just fill in this form, and you will be exactly as qualified as Groves for a few hundred pounds. As you can see, it doesn't ask any difficult questions, or ask to see any evidence of study or research in the area in which you wish to claim to be an expert.

So what we seem to have here is a member of the general public who thinks he can interpret the scientific evidence better than people who have actually studied the area, who has seemingly purchased a worthless "qualification" to boost his credibility.

So what claims does he make?

1. There is a conspiracy to suppress natural cures for illness.
Oh no there isn't.
2. A high salt, high animal fat, low fibre, low fruit and veg diet is better for you than the recommended healthy diet.
Not true for cancer risk. Not true for heart attack risk.
3. Fluoridation causes cancer.
It does not.
4. Plenty of sunlight is good for you, and sunscreens are in fact the cause of skin cancer.
Nonsense.
5. Sugar causes cancer.
Nope.

There are others, all as untrue as the above. Groves is only distinguished from the mass of others promoting scientifically groundless untruths about diet and lifestyle on the internet by his promotion of what amounts to the Atkins Diet, instead of vegetarianism.

When he says that his conclusions are "evidence based", this seems to mean that he is taking his own anecdote, and cherry picking a few dodgy papers to support his claims. A proper evaluation of the evidence usually involves someone who didn't buy their qualifications on the internet taking into consideration ALL of the evidence, not just the bits they like.

I'm proud to say that I have just managed to have Groves' website's HON accreditation removed for the second and hopefully final time.

We had sad news this week, as we heard that long-time MM survivor Alison C died on the first of the month. Her obituary said it was peaceful, which is the very least she deserved after all of the help which she gave to her fellow MM patients over the years.

It's National Melanoma Awareness Week in the UK. This weekend you could help with that by attending Katies Midnight Walk. I'll be there, not that that's any inducement.

Kathy has also contributed her story to this site. Thanks Kathy...

Another promising drug with a catchy name passes stage one trials for Melanoma treatment. Details here.

It targets a specific mutation present in 60% of cases, so it will not work for everyone, but something that worked for 60% of people would be a massive leap forward. So far it only gives stage 4 patients four more progression-free months at best.

Let's not get too excited, lots of drugs clear the first hurdle. It'd be nice if its initial promise is borne out, though...

Also in today's medical news, another vaccine is claimed to show an effect against Melanoma in early trials, despite recent advice to rethink the whole melanoma vaccine approach based on an analysis of all studies to date..

Under the Data Protection Act, I have received censored versions of Macmillan's internal communications relating to my complaint against What Now's poor standard of moderation, which make interesting reading.

It is made clear that they know that I did not break the site rules, but simply tightened the rules applying to me until I could not help but break them.

This was done because of a campaign of complaints against me by promoters of alternative medicine.

The decision by the Chief Exec to support the moderator's decision was on the basis of the claim to him by the moderators that I am the only person other than spammers who anyone ever complained about on the What Now site. Can this really be true?

Despite banning me for "emotive language", Macmillan staff refer in the documents to my official complaint as "all this Sean nonsense", and repeatedly refer to me as being "aggressive", "dismissive", and "patronising" to promoters of quackery as if that were an objective view. They presented their Chief Exec with a highly partial view of the history of my participation, which could only support their version of events.

Back when I was having active treatment, and had a lot of time on my hands, I might have carried this further. With the upsurge I have had in work, and my ongoing Mountain Rescue training, I'm not sure I have the time.

The moderators have been forced to effectively moderate the site for claims of benefit from alternative techniques. My work there is done. For the moment.