At the Melanoma Center, care may include:
- Initial evaluation or consultation
- Second opinions
- Comprehensive surgical care for primary disease or recurrence of any type or location, including: radical local resection, lymphatic mapping, sentinel lymph node biopsy, lymph node dissection, or removal of distant metastatic disease.
- Therapy to help prevent recurrence (adjuvant treatment) following surgery
- Therapy for metastatic disease (distant recurrence) including surgery and or medical treatments
Adjuvant Immunotherapy for Primary Disease or Local/Regional Recurrence
Following surgical removal of all known sites of disease, adjuvant therapy is used to help prevent disease recurrence. Patients who are candidates for this include those with a primary melanoma that is 4.0 millimeters or thicker (stage IIB or IIC), those with involvement of lymph nodes (stage IIIA, B, or C), those with In-transit metastasis (a type of local/regional recurrence- stage lllC) or sometimes those that are near these stages with other adverse prognostic factors. These therapies may involve the use of the following:
Adjuvant Therapies Following Surgery include:
- Interferon Alfa-2b
- Radiation therapy (sometimes used)
Therapy Available For Metastatic Disease That Is Not Surgically Removable include:
Surgical resection of metastatic disease (stage IV) is always the first choice. When this is not possible, multiple therapies are available. This is a rapidly evolving subject. Prior to 2011, single agent chemotherapy (DTIC) or highly toxic Immunotherapy (Intravenous Interleukin-2) were the standard treatments. There are now many new treatments that have been approved in the last few years including:
- Oral Targeted BRAF and MEK Inhibitors such as Trametinib, Dabrafenib, Vemurafenib, and Cobimetinib. These are used only in the setting where a specific mutation is present in a melanoma gene.
- Intravenous Immunotherapy’s (monoclonal “checkpoint inhibitor” antibodies) such as Ipilimumab, Pembrolizumab, and Nivolumab.
Dramatic results have been seen with these monoclonal antibody “checkpoint inhibitors” and many other drugs like them are in clinical trials at this time.
- Intra-lesional Oncolytic Immunotherapy with Interleukin-2 or Imlygic (Talimogene Laherparepvec)
- Intra-arterial Regional Chemotherapy