Detecting and treating melanoma early

Melanoma, the deadliest form of skin cancer, is on the rise in the United States. This year, experts predict nearly 100,000 people will be diagnosed with the disease.

But with early detection and the right care plan, melanoma is also one of the most treatable cancers.

Primary care physicians and dermatologists work together with the UM Cancer Network's medical, radiation and surgical oncology specialists to develop comprehensive care plans, offering some of the latest advances in surgery, immunotherapy and targeted therapies to treat melanoma.

Early Detection and Diagnosis

Melanoma affects the skin cells that produce melanin, the pigment that gives skin its color. While overexposure to sunlight or tanning beds increases one's risk of the disease, melanoma can also develop in areas that don't see the sun like the inside of the mouth or the soles of the feet.

"It's ideal to detect melanoma early when it's small so a patient can achieve optimal outcomes," said Julia Terhune, MD, assistant professor of surgery at the University of Maryland School of Medicine. "Patients diagnosed at the earliest stages of the disease can have up to a 99 percent five-year survival rate."

To detect melanoma in its early stages, Dr. Terhune recommends physicians examine moles and pigmented spots using the "ABCDEs" of the disease:

• A (Asymmetry) – One half of the spot is unlike the other half
• B (Border) – The spot has an irregular, scalloped, or poorly defined border
• C (Color) – The spot has varying colors from one area to the next
• D (Diameter) – Most melanomas are usually greater than 6 millimeters, but when diagnosed, they can be smaller
• E (Evolving) – The spot looks different from the rest or is changing in size, shape, or color

If a spot exhibits any of the above characteristics or if a patient has a history of melanoma, Dr. Terhune suggests a biopsy or contacting a board-certified dermatologist for further evaluation.

In addition to standard full-body skin exams, University of Maryland Medical Center dermatologists offer high-resolution, whole-body pictures of patients' skin to evaluate for changes over time in individuals with many pigmented skin lesions.

Moles that change or look suspicious may require a biopsy. A lab will analyze the skin sample to determine if it is melanoma.

Treatment

Treatment for melanoma depends upon several factors, mostly based on the stage and location of the melanoma. Specialists also take the patients' overall health and co-morbidities into account.

University of Maryland Cancer Network specialists, including pathologists and medical, radiation and surgical oncologists, review melanoma cases during regular tumor board meetings to determine the safest, most effective treatment.

"At our tumor board, an entire group of specialists are collaborating on one patient's care," Dr. Terhune said. "As a result, a comprehensive and individualized care plan can be rapidly developed and implemented."

The first line of treatment in localized, early-stage cases is surgery, Dr. Terhune said.

"If it's an early-stage melanoma, dermatologic surgeons frequently perform the excision in the office setting," she said. "If the lesions are a little thicker or have the presence of ulceration, surgical oncologists would then evaluate for the risk of lymph node involvement, which frequently involves surgically sampling the draining lymph node(s)."

Melanoma is more likely to spread to other organs like the lymph nodes than basal cell carcinoma and squamous cell carcinoma. If lymph nodes are involved, or distant spread has been detected elsewhere in the body, systemic therapy will be considered on an individual patient basis. In melanoma, this frequently means immunotherapy or targeted therapies.

Targeted therapies directly treat the disease often with less toxicity than traditional chemotherapy regimens, while immunotherapy uses patients' own immune systems to fight cancer.

"Immunotherapy is now the first-line treatment for patients with advanced melanoma who are felt to benefit from adjuvant treatment or in the metastatic setting," Dr. Terhune said.

Referral for a clinical trial may be offered for patients who are not candidates for immunotherapy or for patients whose disease has progressed on immunotherapy.

University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) researchers are participating in a melanoma study investigating tumor-infiltrating lymphocytes (TIL). The study has shown promise, and the center hopes to offer additional clinical trials for melanoma in the near future.

Network Benefits

With the NCI-designated UMGCCC as its hub, the UM Cancer Network offers patients access to nationally-renowned experts, cutting-edge treatments and the latest advances in melanoma research.

"One of the great benefits of the network is patients can receive some or all of their treatment close to home but also garner the expertise and specialization our academic centers provide," Dr. Terhune said. "We all work together to come up with a treatment plan individualized for each particular patient."

For more information or to make an appointment with one of our surgical oncologists, call 410-328-7320. To refer a patient to a University of Maryland Medical Center dermatologist, call 667-214-1171.