Researcher Box on a mission to halt spread of melanoma

University Communications
Neil Box performing research in a lab on the CU Anschutz Medical Campus
From left, Cancer Research Summer Fellow Ethan Krauspe and his preceptor Neil Box, PhD, assistant professor of dermatology at the University of Colorado School of Medicine.

AURORA, Colo.—Sunlight streams into Neil Box’s office at the University of Colorado Anschutz Medical Campus on a recent mid-winter day. It’s fitting that his office in Research 2 faces south, as Box is a leading researcher of the molecular causes of melanoma, an aggressive form of skin cancer.

A transplant from Down Under—”Queensland is the melanoma capital of the world,” he says—Box is well-versed in the harmful effects of UV rays. The native Australian is an assistant professor of dermatology in the CU School of Medicine (SOM) and co-founder of the Colorado Melanoma Foundation. Box, PhD, has made it his mission to understand the genetic pathways that lead to skin cancer, to reduce melanoma cases and to raise awareness of sun-safety practices.
Those goals, especially the public education component, led Box and his team to launch the Colorado Melanoma Foundation (CMF) about two years ago. The foundation now partners with the Denver Polo Club for its main annual fundraiser—Mallets for Melanoma—and is getting involved in other community events, including the Colorado Dragon Boat Festival at Sloan’s Lake. “It’s all about being visible in the community and promoting skin cancer and melanoma awareness,” Box says.

Neil Box, PhD
Neil Box, PhD

According to the CMF website, melanoma cases have risen sharply, about 2 percent annually, over the last 30 years, and about 1,400 new melanoma cases are detected each year in Colorado. The state has the nation’s second-highest risk group for incidence of melanoma and the highest risk group for melanoma deaths, says Box, who is also a CU Cancer Center investigator.

“About 200 people die from melanoma every year in Colorado,” he says. “Just by people being more aware of their own bodies, by detecting these cancers earlier, we can save lives.”

‘Angels’ offer support to cancer patients

Because all health issues are inextricably linked to human emotions, the Colorado Melanoma Foundation (CMF) is partnering with Imerman Angels, a national organization that was founded upon the belief that no one should have to fight cancer alone and without support. Imerman Angels provide one-on-one mentoring for all cancer patients, and Neil Box, PhD, assistant professor of dermatology, says the CMF wants to boost services for melanoma patients.

Such support is important because of melanoma’s random nature, Box says. The disease doesn’t usually run in families. Rather, he says, “most melanoma emerges in individuals who have had no family or friends who have experienced the disease, so they don’t understand what the diagnosis means, only that it is very dangerous and possibly even fatal. With melanoma, you are most likely isolated and alone and scared” at the time of diagnosis.

He hopes to recruit local melanoma survivors to serve as Imerman Angels for patients being treated at the University of Colorado Hospital.

In the bigger picture, Box says of the CMF: “We want to bring together researchers, clinical care givers and the melanoma patient survivor community to serve our community at-large on melanoma-related issues.”

Other melanoma-related resources and information:

A combination of high altitude, outdoor-loving residents and 300-plus days of sunshine make Coloradans especially susceptible to melanoma. And data shows that UVA and UVB rays may be the most damaging to children, where early life sunburns are strongly associated with later risk of melanoma.

Box says it’s shocking to find melanoma in children in their mid- to late-teens, but it sometimes happens here. Since 1998, a CU Anschutz research team in the Colorado School of Public Health has been studying a population of over 1,100 children recruited as part of the Colorado Kids Suncare Project. Each year, researchers count the number of nevi (moles) on the children and collect sun-exposure data so they can learn more about the formation of melanoma.

The team is developing new statistical methods to analyze the data from the Colorado children, who this year will turn age 17. Box says the researchers are looking at the molecular signatures of lifetime UV exposure in kids of different mole and melanoma-risk genotypes. The signatures provide information on how risk genes work and how they interact with sun exposure to promote melanoma.

“This could provide better methods of identifying skin cancer and a better understanding of the molecular pathways that might be targeted to prevent melanoma from occurring,” he says.

In the policy arena, the CMF, in partnership with the Colorado Skin Cancer Task Force, is promoting tighter regulations for tanning beds, specifically banning their use by anyone 18 and under. The beds are considered a level-one carcinogen. “It’s well known that early-life exposure is a major risk factor for tumor development for all cancers, but especially melanoma,” Box says. “Colorado has tried four times to get this legislation through. Other states have enacted regulations, so there’s more work to do.”

On another front, Box is working with Bill Robinson, MD, PhD, professor of medicine and medical oncology, SOM, and the melanoma tissue bank team at CU Anschutz. The specimens are being used for genomic sequencing to provide insights into gene mutations that are associated with different types of melanoma.

All of these activities fuel Box’s public-health passion, but he’s especially excited to see how the fledgling foundation can spur melanoma awareness—and prevention—across the state. Also gratifying, he says, is seeing CU Anschutz students participate in CMF’s various initiatives that promise a lasting impact on community health. He looks forward to the day when the foundation, the state’s first melanoma-specific nonprofit, awards its first $20,000 pilot grant.

“This is a way to satisfy our educational mission and our health mission,” Box says. “This kind of enterprise has a lot of value behind the scenes. … It looks like a labor of love, but there’s a lot of activities going on and they all make sense.”

Box’s interests in the causes of melanoma began when he studied almost two decades ago at the University of Queensland, Australia. For his doctoral degree, he identified many of the genetic variants that underlie human red hair. In fact, his landmark research ensured that red hair color was the first normal human trait to be described genetically.

“I think the Queensland experience is relevant to our activities here,” Box says. “Australia is the only place in the world that has been able to effectively combat melanoma incidence. We’ve been looking to them to learn about how to combat melanoma here in Colorado.”