Skin cancer develops when cancerous cells arise from melanocytes (nevi or mole cells), which gives your skin its color. Everyone has these pigment cells, but the cells can sometimes change, either spontaneously or when damaged by sun exposure. With time, this damage can result in cancer.
The two most common kinds of skin cancer are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma account for more than 90 percent of all skin cancers in the United States. It is a slow-growing cancer that seldom spreads to other parts of the body. Squamous cell carcinoma also rarely spreads, but it does so more often than basal cell carcinoma.
What treatment is available at M. D. Anderson - Orlando?
M. D. Anderson - Orlando has the expertise and technology to meet the challenge and improve outcomes for melanoma and all skin cancer patients.
Some of the newest treatment, screening and diagnostic advances for melanoma are available at M. D. Anderson - Orlando. Our specialists use advanced diagnostic imaging and molecular medicine for the most accurate disease staging and treatment planning available.
The treatments we most commonly use include:
- Tailored, wide excisions to achieve an optimal chance for cure without unnecessary disfigurement.
- Sentinel lymph node biopsy and lymphatic mapping to determine early on the risk for subsequent melanoma spread.
- Interferon and investigational programs to help prevent the melanoma from reemerging after surgery (this is called adjuvant therapy).
- Biochemotherapy is used to manage melanoma that has recurred inside the body.
- Clinical trials are given to evaluate the next generation of melanoma treatments.
- Surgical and interventional radiology procedures are performed to treat specific metastases.
- Radiotherapy is used for neurological manifestations of the disease, bone metastases, and to improve the results after surgery.
Surgery is the main treatment for primary melanoma and melanoma in the lymph nodes. A thin melanoma is usually treated with a wide local excision of the skin. In this procedure, an area surrounding the melanoma site is removed. Melanomas 1 mm or more in thickness are considered somewhat more serious than thin melanomas for they may spread to nearby lymph nodes; therefore, a wide, local excision is often done together with a sentinel lymph node biopsy to check for possible spread of the disease.
Intra-Operative Lymphatic Mapping and Sentinel Lymph Node Biopsy
This procedure is usually done at the same time as wide local excision for intermediate or thick melanomas. A small amount of radioactive material and blue dye is injected at the melanoma site. The lymphatic system picks up this tracer material and carries it to the lymph nodes close to the primary melanoma. These lymph nodes (sentinel lymph nodes) are most likely to contain cancer cells if the melanoma has metastasized (spread). The tracer will collect in one or more of these lymph nodes, which are then surgically removed through a small incision and examined under the microscope. The process of checking the lymph nodes for spread of melanoma can take up to two weeks.
Post-Surgery Procedures
For patients with thin melanomas who have had an adequate, wide, local excision alone, no further treatment is recommended. Patients with successful surgical treatment for thin melanomas still need to be checked regularly with physical exams, blood work, and a chest X-ray. Patients with a wide local excision together with a negative sentinel lymph node biopsy (which showed no spread of melanoma) also generally need no further treatment. However, regular checkups are strongly recommended.
Lymphadenectomy
If a removed lymph node indicates the melanoma has spread, a surgeon will recommend additional surgery to remove the remaining lymph nodes in that area. This surgery is called lymphadenectomy or lymph node dissection. In addition, patients whose melanoma has spread to lymph nodes sometimes take additional treatments (adjuvant therapy) after recovery from surgery to help prevent recurrence or further spread. These treatments include medications that carry an FDA indication, such as high-dose interferon-alpha taken over a period of a year, as well as investigational approaches such as new drugs and new biologicals. Furthermore, radiation therapy to sterilize the surgical field can be used in difficult cases.
Advanced Melanoma
Disease recurrence or first presentation in the internal organs such as lung, liver, spleen, or bone has serious implications. Using the multidisciplinary approach, we are now more able to extend people's lives. We are prepared to use FDA-approved drugs (Dacarbazine or newer analogs), biologicals (Interleukin-2) in combination with other common agents (such as Cisplatin, Vinblastine and Interferon) in combination programs known as biochemotherapy or chemoimmunotherapy. Alternatively, we could start with novel, promising agents or even surgery. Ultimately, patients with advanced disease may require multiple interventions to maintain their quality of life, not limited to standard recipes. Clinical trials with new agents are often offered to these patients. In addition to the disease and the treatments, which have manageable side effects, we also offer patients with advanced disease a variety of supportive care programs.
Brain Metastases
Melanoma, if capable of spreading, can at some point become apparent in the brain or spinal cord. This type of spread is not readily agreeable to the treatments we use for the rest of the body, and vice versa. Depending on the pattern of spread, we offer neurosurgery, radiation therapy, or radiosurgery, and opportunities to try new investigational agents.
Sarcoma
After a sarcoma is found and staged, the medical team will recommend one of several treatment options. Most patients with stage I sarcomas have their cancers removed by surgery. Sometimes radiation therapy is done before surgery to shrink the tumor and improve the chance for completely removing it. Radiation may be used instead of surgery if the tumor is considered unresectable (unable to be removed completely). This may occur because the tumor is too large, because it surrounds critical nerves or blood vessels or because the patient has other serious health problems and cannot undergo surgery. Treatment is an important decision, so it is important to take time and think about all of the choices. In choosing a treatment plan, factors to consider include the type, location and stage of the cancer, as well as overall physical health.
Our Team of Experts
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For more information or to schedule a consultation, please call 321.841.1869.