Melanoma Prevention and Early Detection

Advances in imaging, chemotherapy and immunotherapy are combining to create better outcomes for many melanoma patients.

“In past decades, there were very few therapies that worked,” says Carlo Contreras, MD, an OSUCCC – James surgical oncologist who specializes in skin cancer and soft tissue cancers. “Now, we have so many more options, and that’s why I’m so excited about what we can do here as a team for our patients.”

Skin cancer by the numbers

The vast majority of skin cancers are basal cell and squamous cell carcinomas. The yearly total of new cases for these two types is approximately 5.4 million in the United States, with about 2,000 deaths, according to the American Cancer Society. The number of diagnoses for melanoma, one of the most aggressive forms of skin cancer, is about 100,350 with 6,850 deaths.

Compared to other types of skin cancer, melanoma is more likely to metastasize and spread. “This is why these cases need to be treated more aggressively,” Contreras says.

How skin cancer grows

“Melanoma starts with a person’s own pigmented skin cells, which are called melanocytes,” Contreras explains. “Over the years, and because of sun exposure, there can be errors in the genetic code of melanocytes that lead to mutations that grow out of control as the cells replicate.” These cancerous mutations can then spread to other parts of the body through the lymph nodes.

One of the most common melanoma mutations is BRAF, a gene that makes a protein that signals cell growth.

Surgery first

Treatment for early-stage melanoma is “largely surgical,” Contreras says. “The goal is to remove the melanoma growing on the skin and to determine if it has reached the nearby lymph nodes.”

To determine if the melanoma has spread to the lymph nodes, a surgeon performs a biopsy of the sentinel lymph nodes closest to the site of the melanoma. For example, if the melanoma is on the arm, the sentinel lymph nodes in the armpit would be biopsied.

“This is where more specialized and advanced imaging comes into play to help us locate and biopsy high-risk lymph nodes,” Contreras says. He also notes that robotic surgery is used on some patients in which melanoma spreads to groin lymph nodes or abdominal organs.

Treatment options

Immunotherapy, which helps the body’s immune system better identify and attack cancer cells, has been effective in treating melanoma. “The current generation of immunotherapy drugs have less toxicity and are better tolerated by patients,” Contreras says, adding that clinical trials have led to a growing number of effective immunotherapy treatments.

Another option is a two-pill chemotherapy strategy that specifically targets the BRAF mutation that is found in about 60 percent of all melanoma cases.

Contreras leads the OSUCCC – James skin cancer tumor board. “We meet every Wednesday — even now via video link — and it’s an opportunity for all the members of our team to discuss challenges and determine the best plan for each patient. It’s central to the idea of personalized cancer medicine.”

Specialized care center

While rare, some basal cell and squamous cell carcinomas also metastasize.

“This is more likely to happen in patients with already compromised immune systems,” Contreras says, adding that examples are patients who have had organ transplants, autoimmune diseases, such as rheumatoid arthritis or lupus, or are HIV positive.

“We’re a large referral center, which means we see more of these patients with rare basal cell and squamous cell cancers that have spread,” Contreras says. “That’s why our team approach — including medical oncologists, surgeons and radiation specialists — is so important.”

Putting patients first

With each patient, Contreras thoroughly explains the specifics of their skin cancer and walks them through their treatment options, taking care to answer all questions and concerns. “This comes from some great mentors and role models I’ve had over the years, and the realization that this is how I’d want to be treated if I was the patient.”

If you’ve been diagnosed with melanoma, would like a second opinion or would like to speak with a melanoma specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.