- January 22, 2025
Skin cancers are becoming more frequent and affect younger and younger people. Annually, melanoma affects about 3.5 thousand Poles, i.e. three times more than 20 years ago, while basal cell carcinoma affects about 8.5 thousand Poles. Mortality due to melanoma is still increasing. However, early detection gives a chance for a complete cure. For patients with advanced melanoma or basal cell carcinoma of the skin, the only rescue is targeted therapy. In Poland, however, patients do not have access to it.
Overexposure to UV rays is the most common cause of skin cancer. The risk of the disease increases with age - these cancers mainly affect people over 50 years of age, but more and more often they also develop in young people, willing to use sunbathing or solariums. Self-monitoring of the nevi on the skin is important at all ages. If you are worried about their appearance, size or uneven edges, you should go to a dermatoscope for a dermatologist who will have a histopathological examination carried out on suspicion of the cancer. The most commonly diagnosed skin cancers include basal cell carcinoma, which occurs in 80 percent of cases, and melanoma, which accounts for 5 percent.
- In basal cell carcinoma we have different methods of treatment, their choice depends mainly on the severity of the cancer and the risk of relapse. Surgical treatment is still a gold standard. In the case of cancer with a low risk of relapse, we can talk about the use of certain non-surgical methods, such as radiotherapy. However, there are fewer possibilities if the patient has basal cell carcinoma locally advanced or metastatic - says Newseria news agency Prof. Witold Owczarek from the Military Medical Institute in Warsaw, chairman of the Oncological Dermatology Section of the Polish Society of Dermatology.
If the cancer infiltrates the surrounding tissues and develops to a locally advanced stage, surgical treatment and radiation therapy do not bring the expected results.
In Poland, advanced basal cell carcinoma affects about 50 people annually. The only chance for these patients are innovative targeted therapies, including a drug called wismodegib, registered in the European Union in 2013.
- It is a therapy that blocks the molecular mechanisms responsible for the formation of cancer. For patients who already have all therapeutic options in place, this is now the only chance to recover. However, there is a problem, because Polish patients do not have access to this therapy due to lack of reimbursement - says Prof. Witold Owczarek.
Melanomas constitute only 5% of all skin cancers - currently in Poland there are about 5% of all skin cancers. 3.5 thousand patients. The problem, however, is the dynamically increasing number of cases, doubling every 10 years, and the constantly increasing mortality rate - currently one in three patients dies. Melanoma is a completely curable cancer, but its early detection is a prerequisite for success. Meanwhile, the majority of patients report to a doctor when the cancer change exceeds 4 mm - at this stage the mortality rate is already 50%. On average, 35% of patients with melanoma in Poland have a recurrence of the disease - in the case of tumors smaller than 2 mm this percentage is 10%, in the case of larger lesions - 50%.
- Few patients have metastases already at the time of diagnosis. As a rule, this is done sequentially. That is, we perform excision, node biopsy, lymphadenectomy, and only then distant metastases occur - this is related to the parameters of the primary focus - says Piotr Rutkowski, head of the Clinic of Soft Tissue Cancer, Kości and Czerniaków, Oncology Centre - Maria Skłodowska-Curie Institute in Warsaw.
Over the last few years there has been a significant progress in the treatment of advanced forms of melanoma. Currently, 8 drugs are registered worldwide, of which 5 are also available for Polish patients. There are two types of treatment: immunotherapy and targeted therapies. The first method stimulates the immune system, acting independently of the variety of melanoma. For this therapy, three drugs are used, albeit with certain restrictions, that are available under the drug programmes.
- As far as targeted therapies are concerned, the situation is much worse, as medicines (wemurafenib or dabrafenib) are currently only available in monotherapy. Meanwhile, they should be used in combination with the MEK inhibitor, because then they are much more effective in the case of BRAF mutation - says Piotr Rutkowski.
According to the latest research, the combination of MEK and BRAF inhibitors reduces melanoma mortality by 1/3. The use of combined drugs makes the effectiveness of the therapy almost 1.5 times higher in the case of non-progressive experiences and even twice as high in the range of total experiences. Only 5 years ago, three years of experience was only 10 percent, today it reaches even 45 percent. The use of targeted therapies significantly improves the tolerance of treatment by patients, and thus - their quality of life.
