I recently returned from my annual American Academy of Dermatology Conference. No fewer than 18,000 were in attendance from all over the world. The exchange of ideas and techniques with colleagues was exhilarating. Here is a summary of a few impressions I took away.
We are in a new age of treatment for melanoma and atopic dermatitis.
I can personally attest to such a case regarding a patient of mine. Mr. Smith finally came to the office with his daughter and son-in-law, they had pushed him for years. He was a decorated veteran of Pearl Harbor. He had a hard black knot on his bald head. When I saw it, I immediately became very sad. Tears came to my eyes, as I had such a nice time speaking to this jolly fellow. He also had many small dark dots near the area implying local spread.
Now, the prognosis of melanoma is judged by its thickness. More than 4 millimeters, about half the width of your fingernail, means a 90% death rate in a few years. His was more than 4mm just above the skin and there was more below! We took him back to the certified Surgery Center in our office and excised it. It was so deep even the pathologists cringed.
Indeed, it was a melanoma, and at this point, we sent him straight to the oncologist. They did all the studies and fortunately, he did not yet have any internal metastases. He was placed on a medicine called ipilimumab, part of a new cadre of immunotherapies for melanoma. He had weekly infusions of the medication for several months. A miracle! All the melanoma disappeared and has not returned.
There are many more such therapies now available called PD-1 inhibitors. They supercharge a person’s own immune cells to attack the cancer and they are being used now in many other forms of cancer. One brand name is Keytruda, but there are several others, and there are studies now using them in combination.
Atopic dermatitis has a first biologic therapy called Dupilumab. I have seen good results so far in one patient of mine, now 19 years old, who has had eczema since age 5. Side effects are eye irritation and diarrhea, both passing and controllable; better than itching all the time.
More to come in ensuing blogs.
To your health!
