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    Is Melanoma A Death Sentence?

Is Melanoma A Death Sentence?

Dr. Lynn Spitler's Response

A diagnosis of melanoma is absolutely not a death sentence.

Most melanomas (80%) are diagnosed early and are cured by surgery.  The chances of recurrence and/or spread of the melanoma can be determined by the characteristics of the melanoma shown on the initial biopsy.  Further excision is usually done to insure adequate margins, and, at the same time, a sentinel node biopsy may be done if the melanoma falls into a category in which there is concern that it may already have spread to the regional nodes. 

Sometimes the melanoma falls into a category in which there is a heightened concern about spread to other parts of the body.  In this case, consideration may be given to participation in a clinical trial aimed at eliminating tumor cells that may have spread to other parts of the body before the surgical excision of the primary melanoma and/or lymph node metastases.  This treatment is called "adjuvant therapy".  Most adjuvant therapies involve treatments aimed at boosting the patient's own immune responses to help them recognize the hidden tumor cells as foreign and throw them off as one would through off a cold or infection that wasn't supposed to be there.  The only adjuvant treatments currently approved by the FDA for melanoma are interferon alfa2b (Intron-A) and pegylated interferon alfa2b (Peg-Intron) but these are not very effective and highly toxic.

More rarely, the melanoma may spread to other parts of the body and appear as metastases.  The best treatment for these is surgery and this can result in significant clinical benefit.  Whether or not surgery is feasible depends on the site and number of metastases and other clinical considerations.  If surgery is not an option, systemic therapy with pills or intravenous infusions offers hope of benefit.  Until now, treatments for melanoma metastases that cannot be treated by surgery have not been very effective and/or have been highly toxic.  The year 2011 has been a landmark year for therapy of metastatic melanoma.  Two new therapies for melanoma have been approved by the FDA.  These are novel, first-in-kind treatments and offer the potential for significant clinical benefit.  One of these, Yervoy (formally called ipilimumab) was approved by the FDA on March 25, 2011 and is the first treatment in randomized clinical trials to show a survival benefit for patients with metastatic melanoma.  The other, Zelboraf (formally called PLX4032 or vemurafenib) was approved in on August 17, 2011 and similarly offers significant benefit – but is only appropriate for patients whose tumors harbor a mutation in the B-Raf gene.  There is a FDA-approved diagnostic test for this mutation. 

These solutions are not perfect – there is still a long way to go – but the landscape for therapy of melanoma has changed dramatically and, clearly, the diagnosis of melanoma is no longer a death sentence.

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