Melanoma from a Medical Oncologist’s perspective

When I encounter melanoma as a Medical Oncologist, it is usually more advanced that what my Dermatology colleague described on this blog recently.  In my clinic, melanoma cases may be a lot larger, deeper, or ulcerated, or may have spread to lymph nodes or other part of the body.  I am talking about stage II, III or IV melanoma.

Perhaps you, or a family member had higher risk melanoma and has/had to meet with a medical oncologist.  Here are a few things to know:

Sometimes treatments have to be given after the melanoma has been cut out (stage II and III). Here, I am referring to adjuvant therapy and you may want to review this post as a reminder.  Some melanomas have a higher risk of growing back in the same local area or in neighboring lymph nodes, or spreading to other parts of the body.  Some high risk features may include being larger or deeper, having ulceration on the melanoma spot, etc.  Treatments given in this setting serve to reduce chances of melanoma growing back, or spreading.

There is a growing armamentarium of medications that can be used after surgery (stage II and III). For quite a while, we have had interferon to be used to reduce risk of melanoma growing back.  More recently, ipilimumab was introduced, and also works well.  All such medications can have significant side effects so one needs to have a detailed discussion with their oncologist, to determine whether appropriate to use.  Each single case is unique and should be tackled as such.

There are pills that can be used (stage IV melanoma).   Although typically incurable, stage IV melanoma can be treated successfully to slow the course, prolong life, and maintain wellbeing.  Immunotherapy drugs like ipilimumab and nivolumab can be used.  There are pills that can be used in some kinds of melanoma, that have mutations in a gene called BRAF.  Some examples of such pills are dabrafenib and trametinib.

There may be a role for radiation (stage III and IV).  This depends on many unique factors.  Radiation may be given to the local area to reduce risk of melanoma growing back.

There is much room for improvement.  Outcomes are still not as good as we would like.  In one particular large trial, individuals with stage II and III melanoma who were treated with ipilimumab after surgery, had 65.4% surviving 5 years compared to 54.4% among those who did not receive ipilimumab.  About 50% had significant side effects.  This means that we need to do better and one important way to do that, is by having more people enrolled in well designed clinical trials.  For example, BRAF-targeting pills like dabrafenib and trametinib are being studied in stage III melanoma.

Every situation is unique so one needs to have a detailed discussion with their treating physician.  If you found this helpful, do share freely with your family and friends.  Subscribe to my blog to be the first to read my posts as they come up.

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Author of "Self navigate for health" available as eBook on Amazon and paperback on Lulu. Hematology-oncology physician writing about medical self-advocacy or "self-navigation", cancer, blood disorders, and books

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