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Improving the Detection of Melanoma in Active Duty Military

a doctor checks a patient's back in a doctor's office (Image credit: U.S. Department of Defense photo/Tina Staffieri)
By Vivian Mason

Sun-parched days at the beach. Sun-baked days at the pool. Sun-filled days of plentiful outdoor activities. Ah….sweet summer bliss! Well, maybe not. On the other side of that bliss is possible melanoma for sun worshippers who don’t take preventive measures or who don’t take precautions with other potential risk factors.

Chemo drugs in front of a chalk sign that say "Last Chemo 2-16-16 Cancer Sucks!"Immunodermatologist and Army Colonel (Dr.) Jon Meyerle, Associate Professor of Dermatology at Uniformed Services University’s F. Edward Hébert School of Medicine and Chief of Immunodermatology at Walter Reed National Military Medical Center, is not about to take the done out of sun and fun. He enjoys the sun as well, but more than that he enjoys performing research focusing on ways to improve the detection of melanoma in the military population, specifically by studying genetic and environmental risk factors (e.g., a personal and familial history of melanoma, cutaneous and pigmentary characteristics, sun exposure, reactions to sun exposure, etc.).

Melanoma is one of the most common cancers found in young adults, most notably in people younger than age 30. It accounts for less than 1% of skin cancer cases, but causes the majority of skin cancer deaths. Melanoma is the most significant cancer to affect the active duty military population. Considering that the majority of the active duty military population is young and healthy, skin cancer is often overlooked in this group. However, melanoma is of particular interest to the military because these active duty service members are often required to be outdoors for long periods of time and thus are more exposed to sunlight. According to Dr. Meyerle, “The incidence of melanoma is increasing in the U.S. military population, and its associated mortality makes prevention, early detection, and treatment important.”

The most important warning sign of melanoma is a new spot on the skin or a spot that changes in size, shape, or color. A spot that looks different from all of the others can also be a warning. The symptoms of melanoma are often identified by “user-friendly alphabet clues”:
A (asymmetrical areas of a mole, lesion, or skin growth)
B (irregular, scalloped, or poorly defined borders)
C (color variation, especially darkening browns to black)
D (diameter bigger than that of a pencil eraser)
E (evolving or changing in size, shape, or color)

The chance of curing a melanoma is often very good if it’s found, treated early, and removed before it becomes more dangerous. But, if left alone, it can grow and spread quickly, making it that much harder to treat. Melanoma can be fatal. “That’s why I’ve focused on standardized full-body skin imaging,” says Dr. Meyerle (that aids in the early detection of skin cancers). “I’ve performed work in the past on researching melanoma in active duty personnel for the purposes of evaluating diseases of susceptibility markers, which was done using serum from the Department of Defense’s (DoD’s) Serum Repository and tissue from Walter Reed.”

Infographic that says: melanoma; 91,270 new cases will be diagnosed in 2018; 9,320 people will die of melanoma in 2018; more than 20x more common in whites than in blacks; you should: don’t burn, see your physician every year for professional skin examination. Risk was higher among active duty personnel than in general population between 2000-07. All stats from the American Cancer Society and Military Medicine

Dr. Meyerle runs a clinical skin immunofluorescence lab (the only lab of its kind in the DoD) at Walter Reed. It is this background that got him interested in studying melanoma. Typically, melanoma is diagnosed by a pathologist or a dermatopathologist. That person looks at a slide and makes a diagnosis based on visual recognition. Some special stains are also used during this process. But melanoma is often diagnosed simply by a doctor looking at a concerning mole and saying, “this could be melanoma,” then performing a biopsy and relying on a dermatopathologist to make the official diagnosis. That’s the standard, and it’s very effective.

The research concept he participates in uses a more laboratory-based platform for the diagnosis of melanoma and does not rely exclusively on visual inspection. “We used military material that was collected mainly at Walter Reed to provide that tissue repository to see if we could detect melanoma using assays, susceptibility markers, and expression profiles of the tumor, in addition to visual inspection and standard specialty stains to help diagnose melanoma,” says Dr. Meyerle.

A forearm covered in a thick layer of sunscreen with "SPF" written in it
To prevent the onset of skin cancer, generously apply sunscreen that is SPF 15 or higher, wear protective clothing, seek shade when the sun’s rays are the strongest (between 10 a.m. and 4 p.m.), and monitor any changes in your body. (Image credit: U.S. Air Force photo/Staff Sgt. Sheila deVera)

Serial whole-body photography is also used as a method of early skin cancer screening, since a large percentage of deployment medical care is concerned with dermatologic issues. “There are many, many troops in the military (as well as their dependents and family members) who are unable to go right in and see a dermatologist,” notes Dr. Meyerle. “There is also a current shortage of these specialists in the United States. So, access continues to be limited by logistical and financial constraints.”

The idea of serial photography is to photograph a person for the primary detection step, then follow that person over time. For instance, if a person had a mole, that individual could be followed straight through active duty. Also, that person could be checked years later when leaving active duty. If the mole remains the same, then there was no need to biopsy it, thus saving that person from a biopsy. However, if the mole changed, then the patient would need to be fast-tracked to see a dermatologist to remove the mole as a way to diagnose melanoma. Therefore, serial photography could offer dermatologists the ability to work with technology to flag lesions that may require closer evaluation.

Dr. Meyerle explains, “All of these platforms could be used in telemedicine/teledermatology as a way of diagnosing and critically evaluating larger patient populations. Once utilized across the healthcare system, these various platforms could become part of a network of telehealth care.”