With early detection and treatment, melanoma is nearly 100 percent curable. But for patients with advanced stages of melanoma, this skin cancer is often regarded as one of the most deadly forms of cancer. Now, new advances in treatment therapies have provided dramatic improvements for those whose melanoma has spread.
This week on “Take Care,” we talk to Dr. Lynn Schuchter, chief of hematology-oncology at the University of Pennsylvania’s Abramson Cancer Center, about how melanoma is diagnosed and the variety of treatments now available.
Click 'Read More' to hear our interview with Dr. Lynn Schuchter.
When it comes to diagnosing melanoma, Dr. Schuchter says that it is not hard to find. “Diagnosing melanoma doesn’t require sophisticated specialized testing. This is really visual and people being aware,” she says. Melanoma comes in the form of a spot on the skin that looks similar to a mole or freckle.
Once a diagnosis is established, a biopsy is performed, which literally removes the spot right from the skin. While this can be done by a dermatologist or surgeon, it is a pathologist that then reviews the removed spot including measuring how deep the melanoma is, which can say much about the chance of recurrence.
The kind of treatment required is determined by the findings from the biopsy and the recommendations of a treatment team, which is “so very often it is a dermatologist, a surgeon, and if risk is high enough, then also a medical oncologist who is a member of that team to review the overall diagnosis, risk recurrence and overall treatment plan,” says Dr. Schuchter.
“For most patients, fortunately, all that’s required is simple surgery.” For patients with Stage 1 or Stage 2 melanoma, no treatment is often needed beyond that initial surgery.
The most serious treatments will occur for those who have Stage 3 melanoma, which means that the melanoma has spread beyond the initial spot, most commonly to the lymph nodes. Dr. Schuchter says that a test called a sentinel lymph node procedure has changed the way in which lymph nodes are tested for the spread of melanoma. In the procedure, only the lymph nodes that are in the site of drainage for the location of the melanoma are tested. Dr. Schuchter says that the new procedure has minimalized the amount of surgery needed in patients with melanoma that has spread to the lymph nodes.
Therapy for serious forms of melanoma often takes the form of one of two methods: immunotherapy or targeted therapy. Immunotherapy is “designed to rev up the immune system and have it tackle the cancer,” essentially having the body fight it off itself. Targeted therapy is “where we analyze the patient’s tumor and determine what genes are mutated or broken in their melanoma, and then tailor their therapy so that it’s personalized to that patient’s mutation status,” says. Dr. Schuchter.
New approaches in these two forms of therapy “have completely transformed how we think about treatment of melanoma and has had substantial impact on improving overall survival. We think about the ‘olden days’ in melanoma, which was like a year ago, because so much as changed in the last two to three years with many new therapies improved to treat melanoma,” says Dr. Schuchter.
In targeted therapy, new research has shown that melanoma spots have a large prevalence of a gene mutation known as BRAF. Since the recognition of this mutation, three new drugs have been developed and approved for treating it—all within the last eighteen months. Dr. Schuchter says that roughly eighty percent of patients have derived benefits from these drugs, which she says is evidence of the recent improvements in melanoma treatment.
Of course, no medical breakthroughs can come about without testing. Dr. Schuchter tells patients with melanoma to “always consider enrollment in a clinical trial.” Not only do patients get active treatment, but additional costs are often covered by insurance companies. Enrollment can also increase the chance of quicker and more efficient treatments, “because in melanoma, that is the way to get access to the latest and most exciting treatments.”