Oncologist Grimaldi: “Risk factors and Braf mutation role in melanoma”

There are specific factors that can make a difference in the prevention and treatment of skin melanoma, one of the most aggressive skin cancers and one of the most common in young people under the age of 50. “The main risk factors of melanoma are phenotypic, in particular the light skin phototype. Then there are environmental factors, such as high exposure to ultraviolet rays (UV), the consequent burns – especially in children – and excessive exposure to artificial ultraviolet rays – lamps and tanning beds – under 30 years of age “. Thus Antonio Maria Grimaldi, UOC director of medical oncology at the San Pio Hospital in Benevento, in an interview published in ‘Allies for Health’, the portal dedicated to medical-scientific information created by Novartis. “The factors that can lead to suspicion of having a melanoma – says Grimaldi – are summarized in the abbreviation ABCDE: A for asymmetry; B for edges, irregular and indistinct; C for color, because they can be dark or reddish polychrome lesions; D for dimension that can vary, increasing; And for evolution, because the flat lesion can become detected in a short time. In any case, self-diagnosis never replaces the opinion of the dermatologist “. Those who have a clear phototype must pay particular attention to using high photoprotection in exposing themselves to ultraviolet rays. These people “are prone to sunburn – adds the oncologist – they take a long time to tan and need very high sun protection. Red or blond subjects, compared to those with black or dark hair, have a relative risk of developing melanoma from 50 to 100% higher “. 6 phototypes were characterized that correspond to the levels of melanin (a pigment that protects from UV rays) present in the skin: the lower the melanin, the lighter the skin, eyes and hair and the lower the phototype value; the higher the melanin, the darker the skin, eyes and hair and the higher the phototype value. In other words, those with phototype 1 have milky white skin, reddish-blond hair, light, blue or light green eyes: they burn very easily in a short time and cannot get a tan. “The counterpart – specifies Grimaldi – is phototype 6: dark skin, black hair, dark eyes, they tan very intensely and never burn. possible exposure to UV radiation especially from artificial sources which, regardless of the phototype, are harmful “.” The search for V600E mutations of the Braf gene – warns Grimaldi – is the first instance molecular analysis in patients with melanoma – especially if melanoma is inoperable or metastatic – and must be done before any treatment, at the time of diagnosis of advanced disease, to ensure the best therapeutic path “. This test “is performed on the histological sample of the metastasis – continues the oncologist – and, if this is not possible, on the sample of the primitive melanoma. In the third stage, radically operated, the determination of Braf is performed on the histological sample of the lymph node metastasis”. “What we know – underlines Grimaldi – is that in the presence of the mutation we can use Braf inhibitors and Mek inhibitors”. As is known, Braf is a gene from which a protein that regulates the growth of cancer cells is derived. Mek is another protein involved in these regulatory mechanisms. When the Braf gene is mutated, the protein is altered and continuously stimulates the growth and proliferation of cancer cells. The Braf inhibitor drug (Brafi) blocks the protein, the Mek inhibitor (Meki) strengthens the blocking of the process, acting on another point further downstream from Braf, and thus stops cell proliferation. “The association of these two drugs – observes Grimaldi – has changed the prognosis of patients both in the metastatic and adjuvant phase”, that is, after surgery. Braf maturation is present in approximately 50% of melanoma patients. The guidelines of the Italian Association of Medical Oncology (Aiom) provide for the evaluation of Braf in the third (operated or not) and fourth stage melanoma. “This mutation – concludes the oncologist – has a negative prognostic value, but has a predictive value of response to targeted therapies. The use of Braf and Mek inhibitors in combination has given exciting responses. All facilities should guarantee their patients the right Braf mutation test. At the San Pio Hospital in Benevento it has been available since February 2022 and thanks to this we have been able to guarantee targeted therapy to our patients who have been mutated in Braf “. The complete interview is available on: https://www.alleatiperlasalute.it/la-mutation-braf-nel-melanoma-di-cosa-si-tratta.