Langford Webb, who had never had any suspicious spots or moles, first noticed a knot under his arm while bathing two years ago.

Published May 9th, 2019

Langford Webb, who had never had any suspicious spots or moles, first noticed a knot under his arm while bathing two years ago. The 70-year-old Wilmer resident and Marine Corps veteran sought treatment at a Veterans Administration facility in Biloxi, Miss.

The diagnosis of melanoma, the most lethal of skin cancers, was stunning. “The doctor looked at us and told us, ‘You have Stage 4 cancer,’” recalled his wife, Becky. “We just looked at each other and said, ‘Okay.’”

But there was hope for Webb, who has nine grandchildren and two great grandchildren. The doctor referred him to medical oncologist Dr. Art Frankel at USA Health Mitchell Cancer Institute, who prescribed two immunotherapy medications. “He had a dramatic response,” Frankel recalled.

Once Webb started treatment, he immediately returned to work at Webb’s His and Her Chop Shop in Mobile. Also, he and his wife are looking forward to dressing up as Santa and Mrs. Santa next Christmas, something they do each year as a gift to the community. “When he smiles, he looks so much like Santa,” she said.

In the past 10 years, scientific advances have transformed the treatment of melanoma, said Dr. Harrison Howard, surgical oncologist and associate professor of surgery at the Mitchell Cancer Institute. New medications and regimens have helped to increase the average five-year survival rate for Stage 4 melanoma patients from 5 percent to 55 percent often with little or no side effects, he told a recent audience at the Strada Patient Care Center in Mobile. Stage 4 indicates cancer that has spread to other sites in the body.

“We’ve seen remarkable advances,” Howard said. “The only meaningful treatment we had in 2009 was surgery.”

Immunotherapy introduced

Immunotherapy was introduced in the treatment of melanoma in 2010. When Ipilimumab, a monoclonal antibody that targets CTLA-4, was combined with surgery, five-year survival rates jumped to more than 40 percent. “The treatment affects your own immune system, so even when you’re not getting the drug, your immune system is trained to attack the cancer,” Howard explained.

Then came the next generation of drugs such as pembrolizumab, an anti-PD-1 checkpoint immunotherapy that supports the immune system’s response. Former President Jimmy Carter was given this treatment after his melanoma had spread to the liver and brain.

Howard was trained by melanoma experts – most notably the late Dr. Donald Morton at the John Wayne Cancer Institute in Santa Monica, Calif. Morton developed a technique called sentinel lymph node biopsy, which involved injecting dye into a patient’s tumor and tracing the spread pattern to the nearest lymph node.

Morton theorized correctly that this “sentinel” node acted as a gatekeeper for the spread of cancer, and that if it was found to be cancer-free, so would other, more distant nodes. The procedure he developed helped patients avoid unnecessary surgeries.

Howard brought this research interest in better therapies for melanoma when he joined USA Health in 2018. “Dr. Morton said that melanoma is the most malignant of cancers,” he said. “For small tumors, they can wreak real havoc.”

Research at Mitchell Cancer Institute

Scientists at Health Mitchell Cancer Institute are conducting basic scientific research to better understand skin cancer and find new ways to treat it. Frankel’s research, for instance, looks at microbiome signatures associated with a response to immunotherapy in melanoma patients.

Other scientific research has included studies on tanning practices, the effects of sunless tanning chemicals on cells and skin cancer prevention with the use of silver nanoparticles.

Skin cancer and prevention

Basal cell carcinoma and squamous cell carcinoma are by far the most common skin cancers. Melanoma, which forms in the skin cells that produce brown pigment, accounts for only 1 percent of skin cancers but causes the greatest number of skin cancer deaths.

The source of Webb’s melanoma is not known, doctors told him. But to prevent most skin cancers, healthcare providers urge people to limit their exposure to UV rays from the sun.

Howard recommends staying in the shade during midday hours, wearing a hat, wearing clothing that covers arms and legs, wearing sunglasses and applying broad-spectrum sunscreen with an SPF of 30 or higher, and reapplying every two to three hours. Other recommendations: Avoid the use of tanning beds or sun lamps. Visit a dermatologist for a skin screening yearly to watch for changes in moles and other skin spots.

Kristen DeLaney of Mobile, a two-time melanoma survivor, is active in spreading the word about prevention. She was diagnosed as a college freshman after she had a mole removed from her chest. Fifteen years later, she found a light pink bump on her calf, which brought about a wide excision on her leg and skin grafts to repair the damage. She initially sought treatment out of state, before the Mitchell Cancer Institute developed its expertise in melanoma and was designated a Melanoma Center for Excellence.

Now she is cancer-free.

“I am grateful for the Mitchell Cancer Institute and all it is doing in the fight against cancer,” said DeLaney. “MCI is not only on the cutting edge of cancer treatment and research, but it is also raising cancer awareness in our community.”

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