By David Perez, BA, Georgetown University School of Medicine and Rebecca I. Hartman, MD, MPH, Professor of Dermatology, Brigham and Women’s Hospital and Harvard Medical School and member of the MRF Board of Directors

National data suggests Veterans are 1.7 times more likely to develop any skin cancer and 2.3 times more likely to develop melanoma, the deadliest form of skin cancer.¹ Other risk factors including age, sex, race, ethnicity, area of residence and work-related exposures to toxic chemicals and radiation from flight, have also been associated with increased skin cancer risk among Veterans, most of whom are non-Hispanic White men, older than 65, and reside in rural areas with restricted access to healthcare.^2-5 Although some studies have reported less use of sunscreen and shade as well as a lack of skin cancer risk knowledge in active duty service members,⁶ other studies have not replicated this finding in Veterans.¹ Additionally, from 2009 and 2017, Veterans experienced slightly lower five-year melanoma survival rates than the general US population, although Veterans experienced a significant improvement in metastatic disease survival from 2015-2017, more so than the general population, possibly reflecting improved access and/or improved response to new treatments like immunotherapy.^7-8 While new treatments such as immunotherapy have improved outcomes for Veterans with advanced melanoma, these treatments have high costs and potential side effects and not all patients respond, making efforts to reduce new cases of advanced melanoma critical in this high-risk population.^8-9 

Although the risk of any type of skin cancer is elevated among Veterans compared to the general population across age groups, fewer than one-third of Veterans report receiving a full-body skin exam.^1,10 Research suggests that for Veterans, seeing a dermatologist regularly, approximately every 6 to 12 months, may be associated with earlier detection of melanoma, before it becomes thick and harder to treat.⁴ Other studies indicate that biannually screening non-Hispanic White males aged 60 years or older, including Veterans in this demographic population, may be cost-effective, but more research is needed to examine the effect of tailored skin cancer screening in Veterans on skin cancer outcomes.^4,11 

To reduce skin cancer risk in this population, potential strategies include raising awareness about sun protection, making sunscreen more available, and providing personalized medical treatments.^12–14 Increasing access to dermatology care through teledermatology can also be useful, particularly for veterans in rural areas. Training primary care doctors to recognize concerning skin lesions would help ensure that Veterans receive timely care without needing dermatologic referrals and do not undergo unnecessary biopsies. Novel technologies may also improve the speed and access of skin cancer diagnoses, especially in rural populations.  

Melanoma represents a preventable yet fatal risk to Veteran health, making it an urgent public health concern. To address the elevated risk of skin cancer among Veterans, public health initiatives should prioritize education, early detection and improved access to care. Ongoing research is needed to better understand the factors driving this risk and to identify effective strategies for preventing and treating skin cancers in this population. 

References 

Rosenberg, A. R., Tabacchi, M., Ngo, K. H., Wallendorf, M., Rosman, I. S., Cornelius, L. A., & Demehri, S. (2019). Skin cancer precursor immunotherapy for squamous cell carcinoma prevention. JCI insight, 4(6), e125476. https://doi.org/10.1172/jci.insight.125476  

I trusted my gut (and really wanted glasses to match my twin sister) and got a second opinion. He dilated my eyes and instantly knew something was wrong. He could clearly see a melanoma tumor wrapped around my optic nerve and immediately called in for a same-day appointment with an ophthalmologist. My diagnosis was confirmed and I was off to Stanford to meet with an ocular oncologist just a couple days later. I had enucleation of my left eye two weeks after my wedding.

If it wasn’t for a dilated eye exam we wouldn’t have caught this scary tumor. We also learned I have the genetic condition BAP1 which causes all kinds of other cancers. I’m now being monitored regularly and am happy to say I’ve been cancer free since 2018!

Also, random side note: four months later I found out I had two (unrelated) brain aneurysms. One had started leaking — a precursor to rupture — and if it wasn’t for cancer and that feeling something was off, I’m positive I wouldn’t be here. Second random side note: my same optometrist found my friend’s brain tumor two years after he diagnosed me through a dilated eye exam!

A dilated eye exam started all of that and is the easiest way to detect ocular melanoma!

The scan showed something unusual. My eye was dilated, and my optometrist referred me to an ophthalmologist “just to be safe,” noting that he often sent patients for a second look. A few days later, with my husband waiting in the car because of pandemic restrictions, the ophthalmologist told me I had a large tumor in my eye, and with calm urgency said, “You have uveal melanoma.” I was shocked. They quickly arranged for me to see an ocular oncologist in the same practice just three days later.

After reviewing my case and measuring the tumor, the ocular oncologist presented two treatment paths: surgical removal of the eye (enucleation) or plaque radiation therapy. I decided to proceed with plaque radiation, fully aware that my vision in that eye could be significantly altered or even lost. When surgery began to place the plaque, he discovered that the tumor had grown another 15 to 20 percent in just those three weeks. He was stunned by its aggressiveness and later told me that had he known it would grow that rapidly, he likely would have recommended enucleation from the beginning.

Plaque radiation therapy involves a gold-plated disc embedded with radioactive seeds that is sutured directly onto the eye for several days, tailored precisely to the tumor’s size. Because mine was larger than originally planned, the plaque had to remain in place an additional day to ensure the radiation could reach the entire tumor. He warned me that the extended radiation exposure might severely damage my eye and that there was still a chance I could need enucleation in the future. My mindset at the time was: here we are, we will take it step by step. I held onto both my faith and my hope.

The recovery was long and often painful, and the aftermath has included three years of complications: high eye pressure, ongoing glaucoma treatment, and frequent specialist appointments. My vision is limited, and the eye certainly does not look the same, however it is still mine. You absolutely can live a full, normal, beautiful life with one functioning eye.

Uveal melanoma is rare, diagnosed in only about five out of one million people. Although the primary tumor is local to the eye, this cancer can metastasize, most commonly to the liver, but also to the lungs and bones. There is currently no cure. Recent advances, including a few newly FDA-approved treatments, are helping prolong life, although research still lags behind due to the cancer’s rarity.

Because of the metastatic risk, I have ongoing monitoring with scans every six months. I work with both an ocular oncologist and a medical oncologist. I recently reached the milestone of five years post-diagnosis, something that felt impossible in those first terrifying months. The follow-ups continue, although I move forward with gratitude.

Looking back, I will never forget the expression on my ocular oncologist’s face when I told him my last eye exam had been ten to fifteen years earlier. There is so much that can be seen through a simple eye exam. When life is busy and everything seems fine, annual appointments are the first thing we push aside. I did too. I thought I was healthy. I took my eyesight and my body for granted.

The experience changed everything. In many ways, I see more clearly today with one eye than I ever did with two. I see what matters: slowing down, paying attention, appreciating the ordinary moments, celebrating the gift of another day. There are challenges, of course. Life does not stop being messy. Yet there is overwhelming blessing in being here to witness it all.

My family and friends have been an unbelievable source of support throughout this entire journey, lifting me up through the hardest moments and celebrating each milestone alongside me.

If sharing my story encourages even one person to stop delaying their routine exams, to listen to their body, to take charge of their health, then I believe this journey has purpose. Schedule that eye exam. Get your eyes dilated. Keep up with your medical checkups. Do not wait for something to go wrong. Caring for your health is not an inconvenience. It is an investment in the life and future you want to experience.

I wake up each morning thankful that I am here to say these words. Thankful for the doctors who caught something I could not see. Thankful for that $40 decision. Thankful for every single new day.

Q: What’s happening to my clinical trial if it’s federally funded? 

If you are currently enrolled in a clinical trial, you will still be able to participate in your trial.  

Q: How will the FY26 government shutdown impact melanoma clinical trial sites? 

Not all melanoma clinical trial sites will be equally impacted, but many will be affected by staffing changes and furloughs. If you are currently enrolled in a melanoma clinical trial at a site that receives federal funding or oversight (e.g. NIH/NCI-run-or sponsored trials), you will still be able to participate in your trial.  There may be some changes in operations based on staffing levels but that will be site specific so be sure to inquire locally. Privately funded clinical trials should not be affected by the shutdown.  

Q: Can I be enrolled in a new clinical trial during this time?  

No. Except under exceptional circumstances, trials are not enrolling at the National Institutes of Health or any of its institutes or centers such as the National Cancer Institute.  

Q: Where can I go to find out more information about my specific clinical trial? 

If you have further questions about potential impacts to your trial, visit the MRF’s Clinical Trial Finder Tool or reach out to info@melanoma.org.  

Q: Will I still be able to get my care at the VA? 

Yes. Medical appointments at the VA should proceed as scheduled though some ancillary services may be affected by staff furloughs that may impact wait and processing times.  
 
Q: What will happen to my Medicare benefits during the shutdown? 

You will still be able to enroll, go to the doctor or hospital, receive medical treatment and fill prescriptions. However, there may be long processing times for new enrollees. Telehealth benefits for seniors may be restricted during the shutdown, and it is best to talk to your healthcare provider about your options.  

Q: My patient has questions about their clinical trial options, how should I proceed? 

Clinicians can refer their patients to the MRF to speak to a member of staff for any questions related to clinical trials.  

Q: Where do NIH grant operations stand?  

All NIH grant peer review meetings, advisory council meetings, issuance of new awards and program/grants management activities have been halted. We will monitor closely for updates and share information as it becomes available. 

Q. How does the shutdown impact NIH research? 

Basic science and translational research activities at NIH are being heavily impacted at this time.  Much of the impact is project specific, but we expect the shutdown to slow activities considerably. 

Q: How does the shutdown impact the Department of Defense’ Congressionally Directed Medical Research Program (CDMRP) operations? 

CDMRP business operations, program management and program panel execution will continue. Scheduled panel reviews and deadlines remain in effect for the coming weeks, pending how long the shutdown will last. 

Q: Is the CDC’s Skin Cancer Prevention Program still running?  

No. All CDC prevention activities have been halted at this time.  

Please reach out to info@melanoma.org. 

In the 1960s, the rise of California beach culture made tanning a competitive sport — the darker, the better. As a freckled, fair-skinned kid who’d quickly turn pink on a sunny day, I wasn’t about to join my friends when they slathered baby oil (and in one case, cooking oil) head to toe then literally fried on beach towels spread out on their family driveways. 

Sunscreen was limited and the concept of SPF was so new you couldn’t find anything higher than a 4, which, by today’s standard, might as well be nothing. 

But I did buy into the “tan, don’t burn” promise of one company’s suntan lotion, thinking maybe I’d turn at least a little brown.

A few hours at the city pool when I was 12 proved me wrong.

By evening, I had all the signs of a scorching sunburn: beet red skin, blistered and peeling. I didn’t sleep that night; the bedsheet brushing against me felt like fire.

The next day, our family physician warned me: another bad sunburn and “we’ll be worrying about skin cancer.”

I took his words seriously and never got even a mild sunburn after that. But my only severe sunburn turned out to be more than just a painful memory: Fifty-some years later, I was diagnosed first with basal cell cancer then melanoma.

Spotting the Unspottable

Despite being cautious in the sun, I didn’t prioritize annual dermatology visits until I was in my 50s. For several years, those screenings were quick and uneventful: a thorough skin check and the usual reminder to wear sunscreen. 

Then I developed the tell-tale sign of basal cell carcinoma — a sore that wouldn’t heal — on my forehead. After successful Mohs surgery, I figured that was that: the doctor’s long-ago prediction fulfilled and treated. 

Several months later, though, I noticed a dark spot smaller than a pencil eraser on the side of my thigh. I didn’t have the best view, but it didn’t look like the melanoma photos I’d seen. It seemed so minor I didn’t even bring it up at my next dermatology appointment. But my dermatologist noticed it during the exam.

“How long have you had this?” she asked.

“Yeah, what is that? Maybe two months?”

The biopsy indicated melanoma, stage t1a. A wide local excision three weeks later removed what the surgeon called “classic melanoma.” 

No, It’s Not “Just Skin Cancer”

It’s probably the prevalence of basal cell carcinoma that makes people underestimate other forms of skin cancer. When I told my friends I had melanoma, they generally shrugged it off. Isn’t that just another type of skin cancer, they asked, just not as common? Why are you acting like it’s a big deal? 

When I said it was the deadliest form of skin cancer, they seemed puzzled: You can die from skin cancer? Telling them about someone I knew in high school, whose early stage melanoma returned after 17 years later and killed him, brought that lesson home.  

It’s two-and-a-half years since my diagnosis. but I know I will have to be vigilant for the rest of my life. I check my skin on the first of the month (and I have a hand mirror to help me see every inch). I visit the dermatologist several times a year. My ophthalmologist regularly checks a freckle beneath my retina that’s been there for years.  I’ve invested in UPF50 clothing for rare, prolonged sun exposure, and I just bought a sun umbrella to complement my hat collection. 

Protect, check and repeat has become my mantra, a reminder of a long-ago sunburn that left lasting effects.

While at the conference, I was able to discuss the unique burden that melanoma diagnosis and treatment poses to AYAs due to interference with key developmental milestones unique to this age range. With the help of the MRF, we were able to administer a survey across the nation and gather these needs!  

We found that adolescent and young adult males had different needs than their female counterparts. Males wanted to know how their genes led to their melanoma and feared negative treatment side effects, while females wanted to know more about their melanoma diagnosis. Adolescents and young adults who were actively being treated for their melanoma (e.g. on chemotherapy) needed more help with managing fear and having anxiety than those who finished treatment. Lastly, people being actively treated with ICBs (immune checkpoint blockers, or immunotherapy) needed more help with the current and long-term side effects of treatment. 

The conference was such a wonderful experience! I met so many medical students with such unique passions in the field of dermatology, attended various sessions about cutting edge developments in detection and management of melanoma, and enjoyed excursions and scenic tours throughout the beautiful city of Chicago! I am so thankful for all the help the MRF has provided and am honored to have been able to work with such an incredible team to help make an impact on the AYA population! 

T cell immunotherapies, which harness the power of a patient’s own immune system to target and eliminate tumor cells, are becoming an increasingly promising treatment approach for melanoma, including for patients who do not respond to immune checkpoint inhibitors. However, many melanoma patients experience relapse or poor response after receiving these therapies, which highlights the critical need to engineer improved T cell therapies. As part of the Izar group at Columbia, my work aims to address this important gap.

Remarkably, both pre-clinical and population genetics studies show that single-base DNA changes in our genetic code can dramatically impact a T cell’s behavior – and thus have the potential to powerfully modulate T cell therapies. To this end, we developed methods to precisely engineer thousands of mutations in human T cells at once, accelerating our ability to uncover “needle in a haystack” mutations which enhance their ability to kill melanoma cells. In these genetic “screens,” we discovered several mutations in the AKT1 gene which augmented T cell killing of melanoma cells, providing a promising engineering approach to generate a more robust anti-cancer T cell product.

Thanks to generous funding from the MRF, we will now be able to study these AKT1-mutant T cells in greater depth and extensively evaluate their anti-melanoma activity in a panel of clinically relevant models. First, we aim to understand precisely why they enhance T cell killing of melanoma, giving us better insight into how to further improve future therapies. Next, we are working to test these AKT1-mutant T cells in a clinically relevant mouse model of T cell immunotherapy for melanoma – a closer approximation of efficacy in patients. Finally, we are studying whether these AKT1-mutant T cells can overcome a common mechanism of immunotherapy resistance in melanoma – loss of a protein called CD58, which our group has previously uncovered. We believe that completion of this work has the potential to inform a clinically relevant engineering strategy to improve immunotherapy responses for melanoma patients.

As a cheerleader, Melissa Kultgen grew up in “toxic tan culture” and was bullied for having such pale skin.  To fit in and feel prettier, Melissa recklessly spent hours out in the sun trying to tan her skin, only to get severely burned every time.  Years later, while she was pregnant in 2017, she noticed a mole above her lip begin to rapidly change.  It grew wider and eventually became an elevated lump that hung over her lip.  It hurt.  It cracked.  It bled.  Several of her doctors told her it was “nothing to worry about” and her body was just “doing crazy things because she was pregnant.  “If it bothers you, we can remove it,” they told her.  In February 2018, two weeks after giving birth, she had the lump removed.  The surgeon thought nothing of it and sent the mass in for a biopsy “just for the sake of it.” A week later when she had her stitches removed, the surgeon told her, “I’m sorry, Hun, but you have cancer.  Melanoma.  I already called an oncologist for you.”  

Melissa’s world was catapulted into chaos, newly postpartum and diagnosed with IIC Melanoma.  In March 2018, she had a lymph node biopsy to ensure the cancer had not spread.  She also had a wide local excision on her upper lip to clear the rest of the margin and a cross flap reconstruction to repair it.  Her lips were sewn shut for four weeks for the cross flap to heal.  Then in May 2018, she began her year of immunotherapy to reduce her risk of recurrence.  She received Nivolumab one time a month until April 2019.  During that year, she underwent several more procedures to reconstruct her upper lip.  Her final reconstruction was in July 2019.  Now she has yearly checkups with her oncologist and dermatologist.

Melissa is now a 7-year Melanoma survivor and advocate.  She counts her new lip as a bittersweet blessing as it led her to share her story.  Melissa passionately encourages other women to be better advocates for themselves and to get prenatal and postpartum skin checks by a board-certified dermatologist.  She doesn’t want other new moms to experience the trauma and heartbreak that she had to.

I have always been a lover of the sun … and said I am solar powered several times. I grew up in the 80s, no sunscreen. I grew up going to my family’s lake house, played travel softball for 9 years outside every summer, was a lifeguard, vacationed in sunny spots my whole life, run and am active outside my entire 43 years … until February 17th, 2025. 

I went in for a routine body check and my new dermatologist thought it was melanoma about one minute into my exam. He immediately took a biopsy … it took a week to confirm it was melanoma. I had two facial Mohs surgeries to remove the cancer. They took a piece out of my right cheek the size of a silver dollar. Then it took 60 stitches to close up the hole that was open on my face for 9 days waiting to get clear margins. 

I am two weeks into a topical chemo treatment for abnormal cells that were still detectable. The treatment is 3 times a week for about 2 months. I have mentally prepared for the physical and emotional trauma that comes along with the “C” word, but focusing on it is needed and it won’t last forever. 

I can honestly say this has been the hardest thing I have had to deal with in my 43 years. The type of melanoma is genetic, so it was hard to detect, but hopefully not tricky to treat. 

I partnered with the Melanoma Research Foundation out of DC to raise money to support others diagnosed and to ultimately cure melanoma. 

May is National Melanoma month, so I have been busy working to raise awareness before summer. I am sharing my story with NBC 5’s Evrod Cassimy. He will come to my first chemo treatment and interview my doctors and myself, as well as the CEO of the Melanoma Research Foundation.  You can see my story on NBC 5 here.

I am working with IL State Representative La Shawn Ford to make the 1st Monday in May every year … Mika’s Melanoma Monday … to remind people in IL to get an annual skin check, because early detection is KEY! 

I am also running in the annual Miles for Melanoma on July 20th at Montrose Harbor, so please sign up and join me. Here is my team’s page.

As you can see I have been busy trying to immerse myself in this world so I can stay healthy and help others.

Thank you to everyone for reaching out, the texts, calls, meals, cards, gifts, messages, flowers and prayers are all keeping me positive and strong. 

First-in-Human Trial of DYP688 Shows Promise in Uveal Melanoma
Uveal melanoma, a rare type of melanoma found in the eye, accounts for approximately 5% of all melanoma diagnoses. GNAQ/11 mutations are observed in approximately 95% of uveal melanomas. PMEL17(GP100) is highly expressed in melanoma cells, including uveal subtypes. This first-in-human Phase I study evaluated the safety, tolerability and preliminary efficacy of DYP688. DYP688 works by targeting GP100 to deliver a QNAQ/11 inhibitor (SDZ475). By targeting PMEL17, the inhibitor is treating cancer cells and minimizing damage to healthy cells. In patients with metastatic uveal melanoma and other melanomas with GNAQ/11 mutations, DYP688 demonstrated a favorable safety profile and showed encouraging preliminary antitumor activity. Early results support the tolerability and potential clinical benefit of DYP688. Ongoing studies include dose optimization and analysis of mutational profiles from tissue and circulating tumor DNA.

With melanoma incidence on the rise, better diagnosis and treatment is critically needed. While the current findings highlight promising advancements in treatment efficacy, further research is essential to optimize therapeutic strategies. Specifically, more studies are needed to determine the most effective sequence and duration of treatments, explore beneficial drug combinations and develop new treatments with minimal toxicity. Additionally, the identification of predictive biomarkers is critical to better stratify patients and personalize therapy.

To learn more about other melanoma topics presented at ASCO, read the full ASCO recap blog here.

Watch our Ask The Expert Webinar: ASCO 2025 Highlights What Cutaneous Melanoma Patients Need to Know here.