Why didn't people put sunscreen in?

"Sunscreens protect against sunburn, but not against skin cancer!" - Interview with Prof. Dr. med. Claus Garbe

Conference President Prof. Dr. med. Claus Garbe, University Dermatology Clinic at the Eberhard Karls University of Tübingen, gives first insights into the focal points and highlights of this year's ADO Congress.

Interview on the 28th German Skin Cancer Congress with conference president Prof. Dr. med. Claus Garbe, University Dermatology Clinic at the Eberhard Karls University of Tübingen.

K. A .: What special accents have been set at this year's Skin Cancer Congress in Stuttgart? In which areas are there new impulses?

Prof. Garbe: An important focus is the current developments in melanoma diagnosis. As an international study by Holger Hänßle, Heidelberg, shows, a self-learning computer program brings better results compared to specialists who need a lot of experience to reliably detect melanoma.

New computer algorithms enable automated melanoma diagnosis, which means that the use of artificial intelligence is being used in diagnostics. That is one of our top topics. Another current focus at the Skin Cancer Congress is that immunotherapy is also carried out successfully in advanced squamous cell carcinoma. Reimbursements are already approved by the health insurance companies, as is the case with Merkel cell carcinoma.

The European Medicines Agency (EMA) is reviewing the approval of the monoclonal antibody against the protein PD-1 (cemiplimab) for the treatment of patients with squamous cell carcinoma that has metastasized or has progressed so locally that it can no longer be operated on. Advanced squamous cell carcinoma is the second deadliest skin cancer after melanoma.

K. A .: Apart from the approaches to improve the effectiveness of skin cancer screening - are there any further advances in the area of ​​prevention and early detection?

Prof. Garbe: There will be a separate session on skin cancer screening and it will be about which accompanying research should be carried out sensibly. So far, the screening is perceived by 30-35% of the population and it is discussed how this can be further improved. There is no progress in prevention. Skin cancer mainly develops from sunbathing.

It is a misconception that sunscreen can protect the skin from skin cancer, it is not. From sunburn, yes, not from skin cancer. Even very low doses of UV radiation cause mutations in the skin. As soon as the skin turns brown, mutations are already triggered.

We expect skin cancers to double by 2030. Skin cancer will come because those who will develop it have already picked up their dose of radiation. Skin cancer develops with a latency period of 20 to 30 years.

The surprising result of a large study of 1,800 kindergarten children was that sunscreens have no effect on the development of skin mutations, whereas clothing makes a highly significant difference. We differentiate between intentional sun when sunbathing and non-intentional sun when covering the body, which protects against melanoma and squamous cell carcinoma.

K. A .: In the dermato-oncological field there have been groundbreaking new treatment approaches in recent years. What new findings on promising strategies will be presented at the Skin Cancer Congress? And how far is the approval of new, effective drugs in dermato-oncology?

Prof. Garbe: One focus of the conference is to ensure that current data on the adjuvant therapy of melanoma by means of targeted therapy, targeted therapy, and checkpoint initiators are presented. Both options significantly reduce the likelihood of recurrence after removal of a high-risk melanoma and thus improve the prognosis.

What is new is that immunotherapy with checkpoint inhibitors is being introduced into the adjuvant therapy of melanoma. Current studies will be presented which show that the risk of relapse can be reduced by 40 to 50% compared to placebo. Because the results are so good, the health insurance companies are already paying for the treatment now. The first drug for adjuvant immunotherapy (nivolumab) was approved at the end of July, and we expect two further approvals (dabrafenib + trametinib, pembrolizumab) by the end of the year. Positive phase 3 studies are available for all 3 drugs.

K. A .: After the immense progress made in recent years in the treatment of melanoma and other skin tumors through targeted therapies, immune checkpoint inhibitors and combination therapies - are there any promising further developments?

Prof. Garbe: Triple therapy was introduced into the treatment of metastatic melanoma - the combination of three different drugs. There are still no reliable results, but two advanced studies that are being discussed at the Skin Cancer Congress.

K. A .: The innovative therapy options are very effective in many cases, but are not always well tolerated. Side effect strategies are a major research topic. Are new developments being presented in this area?

Prof. Garbe: The clinical focus is on the optimal therapy management of side effects. So far, we have far too seldom a standardized management system for recording side effects. These can be severe, especially with combined immunotherapy, often with unspecific symptoms such as dizziness and headache.

Research is in the process of developing tools such as computerized patient feedback on a daily basis. I hope that this development comes quickly and that it is generally affordable.

K. A .: Renowned plenary speakers present current research results in various dermato-oncological areas. What are the congress highlights for you?

Prof. Garbe: We have three top-class keynote lectures that I am really looking forward to. Hans-Georg Rammenee from Tübingen presents his studies on individualized immunotherapy with anti-cancer vaccinations.

So far we have had unspecific immunotherapies and the exciting question is: Is it possible to stimulate the lymphocytes specifically so that a targeted, individually effective therapy can be developed for each patient?

Laurence Zitvogel from the Gustave Roussy Institute in Paris, the largest cancer research center in France, presents the clinical consequences of translational research on immune checkpoint inhibition. In her exciting research on the microbiome, she shows that the success of cancer therapy is also determined by a change in the composition of the intestinal flora.

The microbiome can be determined from the stool. Depending on the composition, the immune response is modulated. This can mean that with certain compositions of the microbiome, strong or weak immune responses arise, and the treatment of the intestinal flora could be the key to the success of the therapy.

Ashfaq Marghoob from the Memorial Sloan Kettering Cancer Center in New York will present new diagnostic methods and discuss the use of computer programs with artificial intelligence that can already beat dermatologists specializing in dermatological oncology in diagnosing melanoma.

K. A .: Which research data are you particularly excited about?

Prof. Garbe: With all the advances made in recent years, we still have problem cases. Not all skin cancer patients can be treated successfully. I look forward to new research results for skin cancer patients with brain metastases. Promising studies on a combination of stereotactic radiation and combined immunotherapy are presented, the evidence is still pending.

Another problem area is mucosal melanoma. These are not caused by UV radiation, so there are not as many mutations as targets for immunotherapy. Another interesting question is what progress has been made for patients with ocular melanoma. About 5 percent of all melanomas develop in the eye. Here there is no lymph supply - and no lymph node metastasis (in cutaneous melanomas 75%) - but the ocular melanomas all metastasize primarily via the bloodstream to the liver.

K. A .: Thank you very much for the interview!

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