It was back.
After battling melanoma for more than a decade, Herbert Schwartz was having a routine visit with his dermatologist last year when his doctor detected three dark spots on his lower left leg.
Schwartz, 83, had previously experienced melanoma — the leading cause of skin cancer-related deaths — on his back and neck. In those two previous cases, he underwent outpatient surgery to remove the cancer cells. This time, the lesions on his leg returned after surgery.
So Schwartz visited Dr. Jose Lutzky, medical oncologist and director of the melanoma program at Mount Sinai Medical Center in Miami Beach, Fla., to undergo treatment to remove the lesions. Lutzky treated Schwartz with oncolytic virus therapy, approved by the Food and Drug Administration last October. In the therapy, a modified live herpes virus is injected directly into the melanoma lesions, where it replicates inside the cancer cells, causing them to rupture and die.
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Schwartz, a retired pharmacist and grandfather who lives in Weston, Fla., is now cancer-free.
Melanoma is the sixth most common type of cancer in the United States, according to the National Cancer Institute. An estimated 76,380 new cases of melanoma are expected in 2016, with an estimated 10,130 deaths projected for the year.
The risk of contracting the cancer is higher for people who have previously had melanoma.
“It increases the chances eight to nine times of a patient having a second unrelated melanoma,” Lutzky said.
To be proactive about preventing skin cancer, people who are fair-skinned, have had a lot of sun exposure, or have a lesion that is bleeding or not healing should visit a dermatologist once a year, Lutzky said.
“Melanoma detected early is highly curable,” Lutzky said.
Another treatment in the fight against melanoma is Mohs surgery, which was developed by Dr. Frederic Mohs in the 1930s to microscopically remove all cancer. Thin skin layers are progressively removed and examined until only cancer-free tissue remains. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. It is usually performed on an outpatient basis using a local anesthetic.
Mohs surgery is recommended for people with skin cancer that is difficult to treat such as a recurring tumor, as well as for skin cancer located on the face, ears or above the neck, said Catherine Balestra, a Mohs surgeon at the Minars Dermatology Skin and Laser Center in Hollywood, Fla.
In 2014, Balestra volunteered for six months to train residents in surgical dermatology at the East African Dermatology Training Center in Moshi, Tanzania, located in the foothills of Mount Kilimanjaro. The center trains doctors for all of East Africa.
“We were able to perform the first Mohs surgery ever in Tanzania,” Balestra said.
Balestra treated nearly 100 patients during her stay in Tanzania. The patients suffered from albinism, a condition where the body produces little or none of the pigment melanin in the skin or eyes. Most people with albinism are sensitive to sun exposure, have impaired vision and are at increased risk of developing skin cancer. Albinism affects about one out of every 15,000 people in Tanzania, according to the United Nations.
Patients were bused in from as far as 10 hours away, Balestra said. It was not uncommon to have a patient with 10-15 tumors that needed to be removed.
“We were able to remove very large tumors, the size of my fist,” Balestra said. “Most of these were life-saving procedures.
“Only 10 percent of albinos in Tanzania live until the age of 30,” Balestra said. “Only two percent live until age 40. Most die due to skin cancer or skin cancer-related deaths.”
Balestra’s husband and their four children, who at the time were ages 5, 8, 10 and 11, moved with her to Tanzania. Before arriving in the country, her daughters, ages 10 and 11, started a community drive in their Key Biscayne hometown and collected 350 pairs of donated sunglasses to give to Tanzanian albinos whose eyes are sensitive to light.
“My family gained a huge appreciation for all the gifts that we had, as simple as they were,” Balestra said. “We had a family, food on our table, and we felt safe. We had all these things that others around us in our neighborhood did not.”
Skin cancer prevention tips
▪ Wear sunscreen that has an SPF of 30 or higher.
▪ Stay away from the sun during peak hours of 10 a.m. to 3 p.m.
▪ Wear sun-preventive clothing like broad-brimmed hats, long sleeves and long pants. Use UV-blocking sunglasses.
▪ Avoid tanning and UV tanning beds.
▪ Apply 1 ounce of UVA/UVB sunscreen to your body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
▪ Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
▪ Examine your head to toes every month.
Sources: Dr. Catherine Balestra and Skin Cancer Foundation