Melanoma now one of the most curable solid cancers
MedStar Health is now curing patients with high-risk and distant metastatic melanoma with FDA-approved and research immunotherapy treatments. Now the standard of care and the backbone for new research studies, these immunotherapies work by restoring the function of tumor specific immune cells inside the tumor, enabling the immune system to fight the cancer on its own. These approaches are not chemotherapy and therefore do not have the side effects traditionally associated with chemotherapy. Instead, side effects are all related to activation of the immune system and can be addressed without altering the effectiveness of the immunotherapy.
We offer a full range of effective treatments for melanoma. Early-stage melanomas can often get treated effectively with surgery alone, but more advanced cancers often require other approaches. Sometimes more than one treatment type is needed.
Options depend on:
The melanoma’s thickness, stage, rate of growth, and any genetic changes
Whether it has spread
Possible side effects
Your overall health
Many melanomas are cut from the skin quickly and easily, with no further treatment needed — in fact, many times the disease is removed during the initial biopsy. If surgery is needed, our expert doctors provide several types:
Wide local excision: Excision is our standard approach, removing the cancer and up to two centimeters of surrounding tissue, with the amount and the degree of scarring dependent on the tumor’s thickness
Mohs micrographic surgery: During Mohs surgery, the cancer is shaved off one thin layer at a time and checked under a microscope. Such a procedure is helpful when the tumor:
Has an unknown shape and depth
Is located in a hard-to-treat spot, especially in the head and neck
Only doctors who are specially trained should perform Mohs surgeries, and we offer this expertise.
Sentinel Lymph node mapping and biopsy
In some cases, our doctors may recommend a sentinel lymph node biopsy with lymphatic mapping (lymphoscintigraphy) before surgery. During this minimally invasive procedure, the doctor injects a dye and a (safe) radioactive substance at the site of the cancer, then watches to see which lymph node it migrates to first — the sentinel lymph node.
The lymph node is biopsied; if found clear, no further action is required. If it is not found clear, one or more lymph nodes may need to be removed — a surgery called dissection or lymphadenectomy, or close monitoring will be needed.
Patients with spread of their melanoma to lymph nodes are generally offered imaging studies to stage their disease and drug therapy to reduce the risk of recurrence.
Reconstruction and grafting
Sometimes melanoma is located in a cosmetically sensitive area, or the doctor had to remove a large amount of tissue. If that’s the case, your dermatologic oncologist will partner with one of our expert plastic surgeons when the surgery is still in the planning stage.
After the surgery, the plastic surgeon repairs any visible scars. For larger tumors, the surgical site is reconstructed with a skin graft, taken from a discreet place elsewhere on your body. The team works hard to ensure you are happy with the final results.
Our experienced radiation oncologists partner with our dermatologic oncologists to deliver the latest melanoma radiation therapy — high-energy rays or special radioactive sources that damage cancer cells and stop them from growing.
- External Beam Radiation therapy: External beam radiation uses a large machine to aim high-energy radiation beams at your cancer from outside your body. Our specialists treat as small an area as possible to avoid causing unnecessary damage to your healthy tissue.
- High-Dose Rate (HDR) Brachytherapy: This is a method of brachytherapy that delivers radiation to the lesion at the surface of the skin. In HDR brachytherapy, a radioactive wire is attached to a highly specialized robotic machine. The robotic machine carefully guides the delivery of the radiation directly into the tumor and removes the wire after the session.
- Total Skin Electron Therapy: Rotational Total Skin Electron Therapy (RTSEI) and static Total Skin Electron Irradiation (TSEI) are advanced approaches to treating this skin disorder. During TSEI, a patient's entire skin is treated with low-energy electrons. This radiation penetrates very superficially, protecting internal organs and other structures.
- Proton beam therapy
Skin cancers can respond well to radiation therapy, and we may recommend it when:
- You’ve had surgery for a type of melanoma called desmoplastic melanoma
- The cancer is located in a place that’s hard to treat with surgery, such as the eyelids, tip of the nose, or ears
- The cancer was not responsive to drug therapy and involves limited areas
- The cancer has spread to high risk areas such as the brain
Melanoma is often resistant to chemotherapy, and targeted therapy is usually a better choice when the disease has advanced. But chemotherapy can help relieve symptoms or extend survival for some patients; it can also help save limbs in some cases.
Our doctors have the skill and experience needed for complex procedures that temporarily cut off circulation to an arm or leg, then deliver chemotherapy just to that limb. Such treatment can save the limb and is often recommended when melanoma has returned to that area, with a number of confined tumors that are untreatable with surgery. There are two approaches:
- Hyperthermic Isolated Limb Perfusion (HILP): HILP involves surgery and heats the chemotherapy’s route to make it more susceptible to the drug
- Isolated Limb Infusion (ILI): ILI is not a surgery, but a minimally invasive procedure that uses catheters threaded through a small incision into veins and arteries. The procedure is shorter, and easier on frail and elderly patients, as well as in cases where a patient might need more than one treatment
Both approaches provide advantages when compared to delivering systemic chemotherapy throughout the body:
- Higher doses than could otherwise be given
- More effective in such cases
- Avoid amputation
We continue to explore new chemotherapy options in clinical trials, including the possibility of identifying each melanoma’s particular resistance and susceptibility.
Targeted therapy or immunotherapy for melanoma
Targeted therapy represents a new way to treat melanoma, encouraging your own immune system to fight the cancer or focusing on specific genetic changes that help the disease grow. Targeted therapy is typically an option for advanced melanoma, though one drug, the synthetic protein Interferon, is occasionally given after surgery.
Sometimes targeted therapy works when chemotherapy doesn’t, and sometime the two treatments are paired together in a new approach called biochemotherapy. Targeted therapy represents a promising front for melanoma treatment, and appropriate patients may qualify for one of our clinical trials. Drugs that are already approved include those that:
Target Genetic Changes: Given as pills
Help the Immune System (Immunotherapy): Given as an IV infusion or an injectable vaccine, boosting the immune system or removing proteins that normally keep it in check
Melanoma follow-up care
Your physician will want to see you every three to six months following your treatment if there are no signs of active cancer. You may need to repeat any of the diagnostic tests to make sure the cancer is not returning.
Malignant melanoma can return after treatment. To protect yourself from a recurrence, you should:
Stay out of the sun, especially during the hottest hours of the day
Always protect your body from the sun with hats, long sleeves, sunglasses, and sunscreen
Regularly check your skin for new or changing moles or other marks
Awards & Recognition
The MedStar Georgetown University Hospital Lombardi Comprehensive Cancer Center is the only National Cancer Institute (NCI)-designated comprehensive cancer center in the Washington, D.C. region.