The Skin Cancer Foundation Journal

MAY 2014

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

Issue link: http://skincancer.epubxp.com/i/319518

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59 P rominent New York City der matologist, Diane S. Berson, MD, can swiftly spot the warning signs of skin cancers. Yet even she was caught of guard to learn that the shiny, benign-looking, cyst-like bump on her mother's forehead was a Merkel cell carcinoma (MCC), a rare, virulent skin malignancy usually caused by sun exposure. The disease quickly spread to her lymph nodes, and just six months after being diagnosed, Dr. Ber- son's beloved mother Florence passed away in 2007 from complications of the metastasis and subsequent treatment. "If this hadn't happened, she would have had an active lifetime ahead," Dr. Berson la- mented. "She turned 80 on her frst day receiving chemo in the hospital, but was more like an energetic 60-year-old. To the last moment, she was the smart- est person I've ever known. We were very close; she was always the frst person I called to get together when I had free time." Florence was many things throughout her life: an incred- ibly supportive mother of two daughters , opera singer, travel agent, English teacher, and eventually, ofce manager for her husband's psychiatry/neu- rology practice. She was also a beach enthusiast, which raised her risk for skin cancer; about half of all MCCs occur on sun-exposed parts of the body. "Her favorite thing was to walk or read on the beach," Dr. Berson re- lates. "She was fair-skinned, blue-eyed, and blonde-haired, as am I." Thus, she was highly vulnerable to sun damage. After earlier bouts of both basal cell and squamous cell carcinomas, Florence improved her sun protection habits, but she could not eliminate a lifetime of sun damage. This time the skin cancer was lethal; 40 percent of MCC patients die within 5 years. As a dermatologist, Dr. Berson found herself even more frustrated than the average person. "Finding out the diagno- sis of this small lesion led to frustration, as there was a lack of consensus then on how to manage this kind of tumor," she explains. After surgery, followed by two courses of radiation, the only op- tion available was chemotherapy, which in many cases kills the patient before it kills the cancer. In part, that's because MCC is so rare; though the fgure has tripled in the past 20 years, only 1,500 new cases are diagnosed annually in the US. "More public recognition about this cancer came a little after my mother's death, with the discovery that a specif- ic virus is also involved in this disease." Studies may ultimately show how to ad- dress the growth of the virus. "Research is very important, so that future fami- lies have more options," says Dr. Berson, whose father also died from side efects of chemotherapy. "We might have been luckier with more targeted (less dan- gerous) therapies. There is still so much more to learn." One thing is certain, notes Dr. Berson. "People must re- spect any new or changed skin growth — even if it looks harmless. I'm sure many people with MCC are diagnosed late because it doesn't always appear to be a malignant le- sion. As a daughter, I lost my mom and best friend; being a dermatologist made it that much more difcult. " An Ordinary Bump, a Shocking Diagnosis Florence loved lounging and reading at the beach. 50 % Half of all MCCs occur on sun- exposed parts of the body. 3X The number of Merkel cell carcinoma cases that are diagnosed annually in the US has tripled in the past 20 years. 40% 40 percent of MCC patients die within 5 years. Photo provided by Diane S. Berson, MD Health

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