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Health // Doctor in the House
Rasa Fournier

Melanoma Awareness Month

Dr. Shane Morita
Surgical oncologist at The Queen’s Medical Center

Where did you receive your schooling and training?

I was born and raised in Hilo. I obtained my M.D., M.S. and Ph.D. at the University of Hawaii John A. Burns School of Medicine. I completed my surgical residency at Harbor-UCLA Medical Center’s David Geffen School of Medicine at UCLA.

I received specialized surgical training at the National Institutes of Health’s National Cancer Institute, as well as The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, where I also served as faculty.

How long have you been in practice?

I have been at The Queen’s Medical Center and the University of Hawaii for approximately five-and-a-half years.

What do oncologists do, and what interested you in the field of oncology?

Oncologists are physicians who treat patients with cancer. There are three principal types of oncologists: surgical, medical and radiation.

As a surgical oncologist, I operate on patients with tumors, conduct research, teach residents and students, and perform other tasks such as overseeing clinical trials.

Oncology has always been interesting to me – when I was 18 years old, I worked on a research project focused on cancer. I was fascinated by how a cancer cell affects the human body.

When my father was diagnosed with terminal cancer 10 years ago, it solidified my desire to pursue this specialty. As a surgeon, there is nothing more priceless than seeing a patient, whom I had a chance to take care of, out with their family and enjoying life after their operation.

This is Melanoma Awareness Month. What is melanoma?

Melanoma is a type of cancer that affects the pigmented cells of the body called melanocytes. It can originate in the skin, eye, or internal organs such as the intestines.

Melanoma is the only cancer that is increasing in incidence for both men and women.

How prevalent is melanoma in Hawaii?

Melanoma is one of most common types of cancer in Hawaii. It is estimated that approximately 400 patients will be diagnosed in 2014.

What is non-skin melanoma, and how many different kinds of melanoma are there?

Although melanoma is typically known as a (cutaneous) skin cancer, in less than 5 percent of cases it can begin to grow in other sites. The two main types of melanoma (non-cutaneous) that do not arise from the skin include ocular and mucosal. Ocular melanoma involves the eye, and mucosal melanoma affects the lining of internal organs, such as the gastrointestinal tract, nasal-oral cavity and urogenital system.

How does a person develop melanoma?

Cutaneous melanoma is typically attributed to ultraviolet radiation, such as intense sun exposure or tanning bed utilization. Melanoma also can be inherited and associated with certain genes.

Another population that is at risk for developing melanoma is the immunosuppressed, such as those that have received a transplant or have been afflicted with HIV.

Since melanoma is generally related to sun exposure, how does a person acquire it in sun-protected areas?

There are melanocytes in many parts of the skin, such as the nail beds, palms and soles of the feet. It is termed acral melanoma. A mutation or alteration in the DNA of the melanocyte causes abnormal growth. Trauma may be an inciting factor.

It is typically associated with the minority population and was the cause of death for Bob Marley in 1981.

Are there preventative measures people can take?

For melanomas of the skin, limiting UV exposure is paramount.

But approximately 15 percent of melanomas occur in absence of UV exposure. Therefore, early detection is also important. Be aware of any changes both involving your skin as well as the rest of your body.

For example, abnormal growth of skin lesions, visual disturbances, atypical- nosebleeds and unexplained weight loss may be clues to melanoma.

What treatments are available?

In most instances, surgery with removal of the lesion is the first line of therapy. If there is spread to the lymph nodes, additional surgery is typically performed.

If there is involvement of other organs then immunotherapy, targeted therapy, chemotherapy, and in unique instances, radiation can be implemented. In 2011, an immunologic agent called ipilimumab was approved by the FDA. That same year, a targeted agent against the acquired BRAF gene called vemurafenib was shown to be effective in improving outcome.

Any latest advances in treating melanoma?

Yes. Pathways affecting melanoma are being elucidated. Dabrafenib and trametinib were FDA approved in 2013 to treat melanoma. In the near future, drugs that enhance the immune system by affecting the program cell death pathway (anti-PD1) will be readily available.

Anything else you’d like to add?

Although melanoma is frequently observed in fair-skinned individuals, it is detected at a more advanced stage in dark-skinned individuals. In our investigation of melanoma in Hawaii, we found that the minority population had an increased risk of death.

It is important to know that melanoma of the skin should be considered if there is:

A – asymmetry, B – irregular border, C – color variation, D – diameter greater than 6 millimeters, and E – evolution. Not all melanomas are dark; they can be flesh-colored.

rfournier@midweek.com

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