Why a Melanoma Diagnosis Doesn’t Mean What It Meant 5 Years Ago

Have you been diagnosed with melanoma? If so, there is some good news. Since 2011, melanoma went from being one of the most lethal cancers to one of the most curable cancers in the United States.

What’s more, even for patients with advanced disease, achievement of long-term, cancer-free survival is now more the rule than the exception. The choices you make for your own melanoma treatment can profoundly affect your health for the better, and it starts with a second opinion.

The Importance of an Accurate Diagnosis

Astonishingly, one-third of early-stage melanoma patients who come to the Georgetown-Lombardi Comprehensive Cancer Center in Washington, D.C., for a second opinion are found to have been diagnosed with either the wrong stage of melanoma or the wrong type of melanoma – both of which often involve completely different risks and subsequent treatment.

Changes in cancer diagnoses may influence things like patient management plans; the size of surgical incisions; the need for additional biopsies; and eligibility for clinical trials with emerging new treatments. All can impact your quality of life in addition to your chances of being cured of your cancer.

Take Your Time with Treatment

When it comes to the treatment of cancer, It is much more important to do the right thing than the expedient thing. Waiting a week or two to make sure that you understand the biology of your melanoma and your treatment options can make a big difference in your care, and this small delay should not impact your health negatively. Some health insurance companies may require patients to get a second opinion.

Seek the Care of a Multidisciplinary Team

In textbooks, we don’t teach how to manage cancers when suboptimal treatment is done first, so using a multidisciplinary team from the start is crucial to developing a treatment plan that considers all options and their impact on subsequent treatment choices.

Additionally, not all physicians possess the same level of experience in all areas – and through interaction with different specialties they are able to learn from each and come to a consensus on your care. For some patients diagnosed with early-stage melanoma, a careful review of the pathology slides by a multidisciplinary team while taking into consideration the clinical presentation might determine that lesion is not a melanoma but a benign mole.

While your medical oncologist will drive your melanoma management, a full team of professionals should be coordinating every aspect of your care to optimize your experience. Depending on the stage and location of your melanoma, you could expect your management to include a:

  • Medical oncologist
  • Surgical oncologist
  • Dermatologist
  • Dermatopathologist
  • Radiologist
  • Radiation Oncologist
  • Pharmacist
  • Plastic surgeon
  • Dietician
  • Genetic counselor
  • Social worker

Second Opinions Really Do Matter

Second opinions can prevent you from undergoing unnecessary treatment, avoiding additional medical expenses, wasted time, associated health risks, and the psychological burden of prolonged treatment.

For example, we saw one young man who was diagnosed with stage three melanoma, which warrants aggressive postsurgical therapy, due to its likelihood of spreading throughout the body. But a closer look identified his cancer as spitzoid melanoma, a form of skin cancer commonly found in young people that never spreads beyond lymph nodes. This change in his melanoma diagnosis meant he did not need to continue with any treatment or medical follow-up.

Another patient came to us after his thin melanoma (less than 1-millimeter-thick) was surgically removed, along with a draining lymph node. The lymph node biopsy was interpreted as containing melanoma cells, which dictated the subsequent removal of all the lymph nodes in that basin.

When he first came to us to talk about further therapy, our team took the extra step to compare the lymph node involvement with the original melanoma and determined that lymph node lesion was actually a benign subcapsular nevus. Thus his melanoma was down staged from stage 3 to stage 1A. Although he had already undergone unnecessary removal of all his lymph nodes, the changing of his stage meant that his prognosis for remaining free of disease recurrence had increased from around 70 percent to about 95 percent, preventing the need for additional treatment.

Research Institutions Can Provide Cutting-Edge Care

All the progress in melanoma treatment over the last 10 years has been based on research. And patients who receive care from research institutions get a chance to benefit today from the therapies of tomorrow. That’s because melanoma teams at research-based facilities often have access to medical developments and treatment options that may not yet be available to oncologists or surgeons or dermatologists in the traditional community setting. So research institutions are more likely to be active in enrolling patients in clinical trials for cutting-edge new therapies.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Network or are ready to schedule a consultation with one of our specialists, call us at 855-546-1815.

Michael B. Atkins, MD, is deputy director of the Georgetown Lombardi Comprehensive Cancer Center and William M. Scholl Professor and Vice Chair of the Department of Oncology at Georgetown University Medical Center. Dr. Atkins is an internationally recognized expert in cancer immunotherapy and the management of patients with high-risk and metastatic melanoma. He directs Multidisciplinary Cutaneous Oncology Center at MedStar Georgetown University Hospital and co-leads the Melanoma Research Program within the MedStar Georgetown Cancer Network, which has multiple, active cutting-edge clinical trials underway for patients with advanced or high-risk melanoma.