Lorraine Rapp: If you would, walk us through what happens when a person finds out their mole or growth is malignant. Who makes that diagnosis and what are the first steps taken once a person gets the diagnosis.
Dr. Lynn Schuchter: Well once a suspicious mole or freckles has been identified, a biopsy is done and that’s literally removal of that freckle or mole. And then a pathologist reviews it under the microscope to establish the diagnosis. And then there is a discussion about various features of the melanoma, and things that we think about is how deep or thick the melanoma is. And that tells us something about the risk for recurrence and therefore plans for treatment. And the treatment then could involve additional surgery and then other therapies to try to either prevent a recurrence of the melanoma or to develop an overall monitoring plan, and that would often involve a medical oncologist, a cancer doctor.
Lorraine Rapp: Is it always that the bigger and deeper melanomas are the ones that are the most serious, the most likely to spread? And, how does a person find out if their cancer has spread?
Dr. Schuchter: So yes, the thicker the melanoma the more likely it could travel to lymph nodes, or to distant sites. And the way we make decisions, if it’s a thicker melanoma, we will sample lymph nodes that drain that particular part of the body. Depending upon whether lymph nodes are involved, or if it’s a very thick melanoma, then we might do scans to determine if the melanoma has traveled or not.
Lorraine Rapp: What is the most common treatment for melanoma that isn’t too complicated?
Dr. Schuchter: For most patients, fortunately, all that’s required is simple surgery. So patients with Stage 1 and Stage 2 melanoma require no treatment. Patients with melanoma that’s more advanced, Stage 3 that involves lymph nodes, there we have an old medicine that’s somewhat useful called Interferon. But we’re always looking for new approaches. And the two broad categories are new types of immunotherapy, therapy that’s designed to rev up the immune system and have it tackle the cancer, and another exciting approach called targeted therapy. That 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. These new approaches with immunotherapy and targeted therapies 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.
More of this interview can be heard on "Take Care," WRVO's health and wellness show Sundays at 6:30 p.m. Support for this story comes from the Health Foundation for Western and Central New York.