President Carter Has Metastatic Melanoma

The former president’s cancer has spread to other parts of his body.

In August 2015, former President Jimmy Carter announced that he had been diagnosed with metastatic melanoma. Carter, who has since turned 91, underwent an elective surgery in early August 2015 “to remove a small mass from his liver.” Carter was then seen at Emory University, in Atlanta, Georgia, for further testing.

At a press conference at the Carter Center, Carter surprised many by revealing that the cancer in his liver is actually malignant melanoma, and that he has four small lesions in his brain as well. During his August 3 surgery, Carter had about a tenth of his liver removed.

Carter was expected to undergo a single course of radiation treatment to his brain, although he may require additional courses later.  He will also receive four rounds of a new immune system-boosting drug. The infusion of pembrolizumab, better known as Keytruda, will be administered at three-week intervals.

In early November 2015, the Carter Center released a statement that Carter is responding well to treatment and that tests have shown no evidence of new malignancy.

What is Malignant Melanoma?

Melanoma is a disease in which cancer cells form in a special skin cell called a melanocyte. Melanocytes produce melanin, the pigment which colors the skin.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer).   

Skin cancer begins in the epidermis, which is made up of three kinds of cells:

  • Squamous cells: Thin, flat cells that form the top layer of the epidermis.
  • Basal cells: Round cells under the squamous cells.
  • Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken.

There are two forms of skin cancer: melanoma and nonmelanoma.

The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body.

Melanoma is the rarest form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips).
Melanoma can occur anywhere on the skin. In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.

What Are the Risk Factors for Melanoma?

Risk factors for melanoma include the following:

  • Having a fair complexion, which includes fair skin that freckles and burns easily, does not tan, or tans poorly; blue, green, or other light-colored eyes; or red or blond hair;
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time;
  • Having a history of many blistering sunburns, especially as a child or teenager;
  • Having several large or many small moles;
  • Having a family history of unusual moles (atypical nevus syndrome);
  • Having a family or personal history of melanoma;
  • Being white;
  • Having a weakened immune system; and
  • Having certain changes in the genes that are linked to melanoma.

Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.

What Are the Signs of Melanoma?

Signs of melanoma include a change in the way a mole or pigmented area looks. Be mindful of a mole that:
 that:

  • Changes in size, shape, or color;
  • Has  irregular edges or borders;
  • Is more than one color;
  • Is asymmetrical (if the mole is divided in half, the two halves are different in size or shape);
  • Itches;
  • Oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).

Also, be mindful of a change in pigmented (colored) skin or satellite moles -- new moles that grow near an existing mole.

For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.

How is Melanoma Diagnosed?

Tests that examine the skin are used to detect (find) and diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help find and diagnose melanoma:

  • Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
  • Biopsy: A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. 

After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.

New Treatment Options for Melanoma

Since 2011, the U.S. Food and Drug Administration (FDA) has approved no fewer than six new drug treatments for melanoma.  These treatments fall into two categories:

  • Molecularly targeted therapies are drugs that directly counteract the effects of mutations in genes that “drive” tumor cells.  These drugs include vemurafenib (Zelboraf), dabrafenib (Tafinlar) and trametinib (Mekinist). 
  • Immunotherapies are drugs that help the body’s own immune system to eliminate cancer cells. Ipilimumab (Yervoy), pembrolizumab (Keytruda) and nivolumab (Opdivo) are in this category and are given by injection.

Combination therapy with two drugs, dabrafenib and trametinib, has become a standard treatment strategy. New research suggests that administering immunotherapy first, and keeping targeted therapy as a backup, might increase the chances of longer-term benefits for patients.

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