WRNMMC, Bethesda, MD  –   The Murtha Cancer Center (MCC) at Walter Reed National Military Medical Center hosted its 2022 Skin Cancer Summit virtually, followed by skin cancer screenings for Military Health System beneficiaries in Outpatient Dermatology Clinic at WRNMMC on June 2.
Retired Army Col. (Dr.) Craig Shriver, MCC director, explained the center has been designated as the Department of Defense’s only Cancer Center of Excellence for care by the Assistant Secretary of Defense for Health Affairs. “We also have a network of sites throughout DoD at eight different hospitals where we have research operations and other types of programs,” he added.
The MCC is also engaged in the federal Cancer Moonshot Initiative, launched by President Barack Obama’s administration in 2016 and under then-Vice President Joe Biden, to accelerate and advance the understanding of cancer and better coordinate between agencies how to intervene in cancer research, diagnose, care and education.
Shriver said cancer presents a readiness issue for the military with more than 1,000 active-duty service members diagnosed with some form of the disease annually. He said a cancer diagnosis can take a service member “out of the fight” for months if not years.
Army Brig. Gen. Jack Davis, WRNMMC director, stressed the importance of people applying sunscreen to help reduce their exposure to the sun’s harmful ultraviolet (UV) rays and lower the risk of skin cancer and sun damage.
“More people are diagnosed with skin cancer than all other cancers combined,” Davis said. He added skin cancer risk is greater for service members and veterans than for most other groups because many of the troops’ missions require them to be outdoors, while some prevent them from wearing sunscreen.
“The good news is skin cancer is preventable and mostly treatable,” said Davis, also chief of the Army Nurse Corps. “I want everybody to be safe.”

CTCL Challenges

Dr. Sima Rozati, assistant professor of dermatology at the Johns Hopkins School of Medicine, discussed challenges in cutaneous T-cell lymphoma (CTCL) during the summit. She said one of the principles to consider in care is, “Best treatment option depends on which body compartments are involved and what stage [is the disease].” Another consideration she stated is “Be aware of the adverse events, even uncommon ones.” She also stressed the “importance of thorough work-ups with new findings. “
Rozati explained that in treating patients, she “organizes the disease into jars or compartments,” looking at the patient’s skin (biopsies), blood work, lymph nodes, and viscera. “When managing CTCL patients, it’s important to make the right diagnosis, [and] staging is the only validated prognostic factor. Also, determine the goals of therapy, consider the patient’s quality of life, [and] reassess and restage with new cutaneous and extra cutaneous findings.”
Although there is no cure for CTCL, it’s treatable, and Rozati explained the goals of therapy should include “attaining adequate response to reduce and control symptoms, and minimize the risk of progression. In addition, the goals of therapy should include “the use of therapies with lower side-effect profiles and an absence of cumulative toxicity,” as well as “improving and maintaining disease control and quality of life.”

What to look for

Dr. Jeffrey North, a dermatologist in San Francisco, California who’s affiliated with multiple hospitals in the area, discussed molecular testing in melanocytic tumors. In addition to treating patients for all types of skin disease, he interprets skin biopsies from across the United States.
North explained there are limitations in melanoma diagnosis, but often, the first sign of melanoma is a change in the size, shape, color, or feel of an existing mole. Also, most melanomas have a black or blue-black area and may appear as a new, black, abnormal, or "ugly-looking" mole.
For more information regarding the symptoms of skin cancer, visit the Centers for Disease Control and Prevention website, https://www.cdc.gov/cancer/skin/basic_info/symptoms.htm.

Skin Cancer and Organ Transplant

Dr. Sarah Arron, a California-based dermatologist who recently served two years as president of the International Transplant-Skin Cancer Collaborative, discussed skin cancer in organ transplant recipients. She explained organ transplant recipients are at a higher risk for developing squamous cell carcinoma than others in the general population. This higher risk is caused by immunosuppressive medications vital to transplant patients to prevent graft rejection and optimize graft survival. Because the medications suppress the immune system’s ability to fight off infection and prevent the development of cancer, transplant recipients are at elevated risk for infection and certain cancers.
“Given enough survival time, almost all patients will fundamentally develop at least one squamous cell carcinoma, and these can range from very small, easily managed surgically [skin cancers], to very large and lethal tumors,” Arron said.
Aaron explained the potential benefits of screening organ transplant recipients for skin cancer include: a possible reduction of morbidity/mortality; the opportunity to educate patients about modifiable sun exposure/lifestyle factors; and the opportunity to identify specific medication-associated risks.
Potential harms include the possibility to increase invasive procedures and complications; an increase in anxiety arising from biopsy; and cost.
Aaron stated that while not all transplant recipients develop skin cancer, all transplant patients are encouraged to examine their skin for lesions once a month, practice adequate sun protection measures, including applying sunscreen and wearing protective clothing, and following up with their dermatologist for regular skin checks.

The MCC

The Murtha Cancer Center is a tri-service center where military beneficiaries can receive care in all disciplines of cancer treatment. It resulted from the integration of the Walter Reed Army Medical Center, National Naval Medical Center, Malcolm Grow Medical Clinic, and the U.S. Military Cancer Institute. The center is named after the late Pennsylvania Representative John P. Murtha, an ardent supporter for veteran health care and other benefits. It includes more than 300 board-certified oncologists and professional clinical and support staff who specialize in all aspects of cancer care from first diagnosis, therapy, follow-up care, to survivorship. The MCC has also teamed with the Uniformed Services University and the National Cancer Institute to provide state-of-the-science cancer care.