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Recent Kohler transplant and research partner achieved melanoma skin cancer breakthrough thanks to 30-year-old tissue samples

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Since 1984, the month of May has been recognized as National Melanoma Month. Coming up this Monday, May 7 will be “Melanoma Monday,” a day set aside each year on the first Monday of May for the purpose of raising awareness about skin cancer.

Melanoma is the deadliest of all skin cancers and the statistics associated with it are staggering. According to The American Cancer Society, it is the most common form of cancer for young adults age 25-29. Incidence has increased 1800% over the last 100 years and 132,000 new cases of melanoma are diagnosed worldwide each year. One American dies of melanoma every hour.

Dr. Jerry Miller.
– Photo courtesy of Forefront Dermatology

While practicing in La Crosse, Wisconsin, Dr. Jerry Miller – a dermatologist who recently became a Kohler resident – and his research partner, Dr. Paraic Kenny, were able to achieve a melanoma skin cancer breakthrough thanks to one of only a handful of long-term tissue banks around the world, affordable next generation gene sequencers, and a little serendipity.

Dr. Miller said that he had been clinically monitoring a patient who had a melanoma surgically resected in 1985. For 30 years his examinations showed no recurrent melanoma. In 2015, the patient presented to Dr. Miller with complaints about a new lump which occurred near his original melanoma surgical site. Dr. Miller suspected a recurrence of his melanoma, but this would be extremely rare. Ultra-late melanoma metastasis had never been scientifically proven. The lump was biopsied and a diagnosis of melanoma was given, but the pathology could not demonstrate if this was a new or recurrent cancer.

Biobank sample array from Gundersen Biobank in La Crosse.
Photo courtesy of Gunderson Health System.

Dr. Miller recognized the research and clinical importance of proving that this cancer had returned. He said that a recurrent melanoma would initiate different treatment and diagnostic evaluations. Dr. Miller then reached out to Dr. Kenny, director of the Gundersen Medical Foundation’s Kabara Cancer Research Institute in La Crosse, who had recently arrived from his research position at the Albert Einstein School of Medicine in New York City. Dr. Kenny was in charge of the Gundersen Foundation’s biobank, which has collected more than 30,000 cancer samples since 1983. Because most hospitals typically dispose of tissue samples after 10 years, the Gundersen biobank is unique because it is one of only a handful of long-term tissue banks in existence around the world. Dr. Kenny was able to find the patient’s original melanoma sample. He then was able to extract and analyze the tumor DNA from 1985 and 2015 using next generation genomic DNA sequencing.

Drs. Miller and Kenny scientifically proved that the patient’s tumors were related. They published their case last June in the Journal of Cutaneous Pathology. Their paper was the first in the world’s literature to prove the existence of ultra-late melanoma metastasis. “It also proved the longest lineal relationship between primary and metastatic tumor of any solid tumor in the world,” said Dr. Miller. “This is an important discovery because it changes how the medical world thinks about the nature of melanoma and cancer in general.”

Dr. Miller explained that the existence of ultra-late cancer metastasis could only be explained by a new theory called the cancer stem cell theory. This theory states that most cancers come from cancer stem cells, which have unique properties of initiating and maintaining cancer, traveling throughout the body, remaining dormant, and then growing at distant sites. Understanding the nature and biology of cancer stem cells will ultimately lead to the ability to control or eliminate the spread of cancer. Their research also demonstrates the power and potential of precision medicine and oncology. Analyzing a patient’s cancer DNA may, in the near future, be standard of care because every tumor is unique in terms of the genes that are mutated. This allows physicians to more accurately treat a tumor with medications more specific to an individual’s tumor.

The melanoma research by Drs. Miller and Kenny will add another brick to the foundation of cancer knowledge. Dr. Kenny said of the biobank, “A lot of stories are hidden in there waiting to be discovered with research.” He will continue his laboratory research primarily with breast cancer, and was gratified that insights into melanoma were discovered.

Dr. Miller currently practices in Fond du Lac for Forefront Dermatology, but beginning in July, he will head the new Dermatology Department for Prevea Health. He will be seeing patients in Plymouth, Sheboygan and Green Bay. “We are on the cusp of a medical revolution with how we diagnose and treat cancer and other diseases, and it’s all because of our ability to analyze and understand DNA,” said Dr. Miller.

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