By Gil Cortes, MD, FAAD
Melanoma is a cancer that begins in the skin cells that create the pigment melanin. Melanoma usually starts as a dark mole on the skin. However, it can also form in other tissue, such as the eye or intestine.
In 2018, an estimated 96,480 patients in the United States were diagnosed with melanoma, and about 7,230 patients died from the disease. Drug development within melanoma has focused on cutaneous melanoma therapeutics and later stages of disease when surgery is not an option.
Melanoma is categorized by stages. A particular stage of the disease gives an idea how far the cancer has spread. Essentially, there are five stages of melanoma. The first stage is called stage 0, or melanoma in situ. The last stage is called stage 4. Survival rates tend to go down at each stage of melanoma. However, It’s important to note that survival rates for each stage are just estimates. Each person with melanoma is different, and your outlook or prognosis can vary based on many different factors.
With that said, just millimeters define the difference between different stages of melanoma skin cancer. A stage 2 melanoma means the tumor has grown just over 2 millimeters in thickness. The five-year survival rate is 70-81% and the10-year survival rates are approximately 60%. A stage 3 melanoma is one that has spread to additional areas besides the skin. At this point, radiation and other medication treatments are
common. The five-year survival rate for stage 3 melanoma drops to 40-78% and the 10-year survival rate drops to 24-68%.
With surgery, melanoma confined to the skin is curable in 95 to 98 percent of cases. Unfortunately, if the lesion recurs (returns), gets thicker, or spreads from the skin to the lymph nodes or distant organs, it becomes much more dangerous.
Melanoma has historically been a disease that is difficult to treat with just medications and drug development made limited progress. This explains much of the high mortality seen with melanoma skin cancer. However, in recent years, developments in molecular biology, have led to an increased understanding of the molecular functioning of melanoma which has resulted in the introduction of new insights into the role of oncogenes, immune checkpoints, and signaling pathways, all of which have accelerated the discovery rate of new medications to treat advanced melanoma. Breakthrough drug approvals in recent years, checkpoint inhibitors and MEK/BRAF combination therapies have prolonged survival and changed the prognosis for patients with advanced melanoma.
Because Melanoma is a type of skin cancer that can change its prognosis for patients with just millimeters of skin penetration. Early detection is always key. Everyone should have at a minimum yearly or annual skin exams by a trained professional to catch melanoma as early as possible. If there is a personal or family history of skin cancer or melanoma, screening is even more important.
Currently the recommended treatment of melanoma is a wide excision to remove the cancer and also evaluation to see if it has spread. If you have advanced melanoma, or it has spread, the prognosis can rapidly change.
If melanoma has spread beyond the skin, treatment options may include:
• Surgery to remove affected lymph nodes. If melanoma has spread to nearby lymph nodes, your surgeon may remove the affected nodes. Additional treatments before or after surgery also may be recommended.
• Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be given intravenously, in pill form or both so that it travels throughout your body.
Chemotherapy can also be given in a vein in your arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don’t affect other parts of your body.
• Radiation therapy. This treatment uses high-powered energy beams, such as Xrays, to kill cancer cells. Radiation therapy may be recommended after surgery to remove the lymph nodes. It’s sometimes used to help relieve symptoms of melanoma that has spread to another area of the body.
• Biological therapy. Biological therapy boosts your immune system to help your body fight cancer. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Side effects of these treatments are similar to those of the flu, including chills, fatigue, fever, headache and muscle aches.
Biological therapies used to treat melanoma include interferon and interleukin-2, ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda).
• Targeted therapy. Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells. Side effects of targeted therapies vary, but tend to include skin problems, fever, chills and dehydration.
Vemurafenib (Zelboraf), dabrafenib (Tafinlar) and trametinib (Mekinist) are targeted therapy drugs used to treat advanced melanoma. These drugs are only effective if your cancer cells have a certain genetic mutation. Cells from your melanoma can be tested to see whether these medications may help you.
Investigational therapies abound for advanced melanoma, however many are still awaiting further study before approval can be made, to ensure safety and efficacy.
Even with the impact of these breakthrough therapies, unmet needs still remain for safer and more effective therapies. The greatest promise in addressing these needs may come in the form of combining novel therapeutics with currently marketed therapies to provide effective treatment and improve patient survival. As always, we recommend sun safety and regular appointments at the dermatologists office for skin exams to catch melanoma as early as possible.
Gil Cortes, MD, FAAD
Practice Owner & Dermatologist
Rolling Oaks Professional Plaza
929 N. US Hwy 441 Suite 603
Lady Lake, FL 32159