Melanoma, don’t mess with Texas!

That’s essentially the rallying cry of volunteers, medical institutions, foundations, and other interested groups in Texas who are each working in their own way to teach prevention and early detection, support patients, and fund research.

Unfortunately, there is much work to do.

The incidence of melanoma in Texas has steadily risen from 1999 to 2017, the latest year for which incidence data are available. In 1999 the incidence rate was 11.3 melanoma cases per 100,000 people, and the 2017 rate was 13.3 cases per 100,000 people. That increase may not look large, but in real numbers, it is substantial. There were 2,022 cases of melanoma reported in Texas in 1999 and 3,754 cases in 2017—an 86% increase. In other words, in less than twenty years, the number of melanoma cases in Texas nearly doubled.

The case numbers above are invasive melanoma. They don’t include in situ melanoma.

As we wait for confirmed case numbers to become available for 2018 through 2020, we can use projected numbers to understand what melanoma looks like today in Texas—and those projected numbers don’t look so good, either. The projected number of invasive cases of melanoma that will be diagnosed in Texas in 2021 is 4,600. Again, this number doesn’t include in situ melanoma.

We know that 495 people died of melanoma in Texas in 2017, a number that is too high because it isn’t zero.

Education, prevention, early detection, advocacy, support, and research all contribute to lowering these numbers. The good news is Texas has had an active community of people and institutions working in these areas for many years, including AIM at Melanoma. The bad news is the melanoma numbers are growing, despite this active community. But without this community, these numbers may have grown larger.

Ten years ago, AIM led the effort, along with the Texas Dermatological Society, to push for the ban on minors under 18 from using indoor tanning devices in Texas, a law that passed in 2013. More than 6,000 cases of melanoma across the U.S. can be attributed to indoor tanning annually, and it was this kind of information that helped move the Texas legislature to action.

Today, Texas and 19 other states and the District of Columbia have full bans on minors 17 and under using indoor tanning devices. These bans around the country are paying off. For example, a recent study found that indoor tanning prevalence among female high school students in states with age restriction laws was 47 percent lower than among those not affected by such laws. A Centers for Disease Control and Prevention (CDC) study predicts that prohibiting indoor tanning among minors younger than 18 years could prevent 61,839 melanoma cases, prevent 6,725 melanoma deaths, and save the U.S. $342.9 million in treatment costs over the group’s lifetime. Specifically, in Texas, we know the ban is working: A 2017 study, that was published in JAMA Dermatology, found that, overall, 81% of facilities in Texas reportedly complied with the ban. So Texas has certainly saved lives, anguish, and money by passing this ban in 2013.

Institutions and medical entities in Texas are also doing excellent work. MD Anderson Cancer Center, University of Texas Southwestern, and Baylor, Scott & White, to name three, perform critical research and offer a multitude of prevention, early detection, and support programs targeting melanoma and melanoma patients.

One program MD Anderson Cancer Center (MDACC) is involved with is the Be Well Communities™ strategy. This program works with communities to promote wellness and stop cancer before it starts. Baytown, Texas was selected as the inaugural Be Well™ community, and city leaders and partners have implemented sun safety interventions to decrease the risk for skin cancer across the community over time. The interventions include installing sunshade structures and sunscreen dispensers, planting shade trees, and implementing sun safety behaviors at schools. MD Anderson has also developed a program called Ray and the Sunbeatables®, an evidence-based sun safety curriculum created at MD Anderson to educate children, parents, and teachers about sun protection and promote sun safety in an effort to reduce children’s lifetime risk of developing skin cancer. Finally, MD Anderson has developed DERMatology, an early melanoma detection program that is scalable metric-driven education intervention to foster the development of mastery level dermoscopic image interpretation proficiency in dermatology residents and providers.

Baylor, Scott & White Health (BSW Health) has a program called Onward: The Survivorship Journey, and the programs have been adapted to function despite the pandemic. Support groups have moved from in-person to virtual. They’ve made brief audio recordings and videos to post on social media sites to continue to reach their patient population with current information. In May they will release a series of podcasts (audio and video); topics to be covered include newly developing research protocols and treatment regimens, surgical techniques and procedures, plastics, and melanoma instances in Texas. The podcasts will be available on Apple, Spotify, Google, and Transistor (audio) under the Onward: The Survivorship Journey label, and the videos will be listed on the BSW Health YouTube channel playlist under the same name.

University of Texas Southwestern (UTSW) offers a host of community outreach programs, including sun safety education for elementary/secondary students and lifeguards—an often-overlooked group of people for whom this education is critical. For their patients, they offer a specialized Pigmented Lesion Clinic, full-body photography, and close collaborations with UTSW Cancer Genetics to screen, identify, and counsel patients with melanoma-predisposing mutations. Of particular importance for the next generation of Texans is the UTSW clinician education programs that include resident physician and medical school student education regarding melanoma risks, prevention, identification, and management, and primary care provider education on the identification of suspicious lesions.

AIM at Melanoma partners annually with Texas cancer centers on patient symposiums, which provide patients with updates on melanoma research, emerging therapies, and survivorship topics—those that address the physical, emotional, and psychological needs of patients. Before the pandemic, these were primarily in-person events. Since last March, we’ve transitioned to online symposiums, which allow anyone, anywhere to log on and listen to the symposium. On April 10, AIM is co-hosting a symposium with MDACC through T.W. Lewis Melanoma Center of Excellence at Banner, and we are hoping to schedule another Texas site in the fall or spring 2022, when we are back to in-person events. AIM also hosts nationwide Walks, called Steps Against Melanoma, which are both fundraisers for melanoma research and community education and support events. AIM has walks scheduled in 2021 in Dallas (October 9, in-person) and Houston (date soon TBD).

Cancer Prevention & Research Institute of Texas—often referred to as CPRIT—is another outstanding entity doing great work. CPRIT was created when Texans voted in 2007 to invest $3 billion in the state’s historic fight against cancer. In 2019, Texas voters overwhelmingly approved a constitutional amendment to provide an additional $3 billion to CPRIT for a total $6 billion investment in cancer research and prevention. Through CPRIT over $23 million has been awarded to melanoma projects.

And of course, there are countless survivors and small non-profits all across Texas who do incredible work for melanoma prevention and support, day in and day out. These two Texans are examples.

Bennie Lunsford of Houston is a Stage IV survivor whose melanoma spread, as he put it, “everywhere: brain, lungs, liver, bones….” It was 2013, and he tried multiple treatments before ending up on a clinical trial at Moffitt Cancer Center in Florida. Just after he finished the trial, another brain metastasis appeared, which his physicians zapped with a CyberKnife. The incredible news: His scans have been clear since that time. His work for the melanoma community is what might be described as peer support—through a blog, Facebook groups, Reddit, and other online groups. At first, his wife joined some online groups, and he wasn’t interested, but once he joined, he realized how worthwhile it was: “This whole world that’s dealing with everything you’re dealing with opens up; it makes you feel like you’re not alone.” These types of groups helped him through, he says, and now he pays it forward by helping others. “Overall, talking with people helps people,” he explains. Newly diagnosed patients or caregivers join the groups, have questions, and want to better understand the disease. “I point them to AIM at Melanoma quite a bit,” he says. He may be based in Texas, but he supports melanoma patients all over the U.S.

A Stage IIIA survivor, Bethany Greenway lives in Austin, and, as she put it, “chose to be very public with my melanoma journey.” A graduate of Parsons School of Design in Fine Arts Photography, Bethany documented her journey by taking a picture and writing a paragraph, and posting these on Facebook  —every day since her diagnosis in 2016. She gained a following, and “it became a little support group.” Her Facebook story was picked up by a large news agency and shared internationally through Today, Allure, USA Today, and other media. The melanoma community started contacting her, and she started volunteering—her activism started there. For example, she’s worked with The Shade Project and Meredith’s Mission for Melanoma, two Texas-based nonprofits. She also did a post for Coolibar’s Be Brave series. At events, in articles, and in postings—her own and others—she speaks about her experiences.  Those who benefit run the gamut, from young people who read her story and take away the importance of prevention and early detection, to late-stage patients who relate to her quest to find peace and the new normal after a cancer diagnosis. Like Bennie, Bethany’s impact is felt in Texas—and well beyond.

We repeat: Melanoma, don’t mess with Texas.