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 Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

How Immunotherapy Gave Leta Brown Her Life Back

Leta Brown had a wonderful life, along with her husband, two daughters and her stepson. But when she was diagnosed with widely metastatic melanoma, she felt the rug had been pulled out from under her and her family. “It was a huge jolt,” Leta shared. “I was left with a really grim prognosis. I wasn’t prepared for that kind of news.”

In April of 2013, a lumpy bruise appeared on the back of her leg. She consulted with her primary care physician, and a leg MRI showed a large metastatic tumor deposit and body CT scans showed additional metastases to her lungs and small intestines.

“When I got the news, it was really hard to get past the finality of it,” Leta said. “That this was going to take away my daughters' mother."

Immunotherapy Clinical Trial with Dr. Atkins

Not long after, while looking for treatment options, she came across an article on immunotherapy. She then found an immunotherapy trial with Dr. Michael Atkins at Georgetown Lombardi Comprehensive Cancer Center, for which she was eligible, due to her diagnosis, as well as her medical and treatment history. He explained to her that cancer cells express proteins that can disable antitumor immune responses; immunotherapy blocks the function of those proteins restoring the function of the immune system so that it can eliminate the tumor cells.

Following a resection (removal) of a large bowel metastasis, Dr. Atkins and his team were able to safely initiate immunotherapy treatments in August 2013.  Her tumor deposits quickly melted away and she was able to return to her daily activities. After one year of therapy, she was disease-free and able to stop treatment without disease recurrence.

“This type of result, while at the time being considered exceptional, is fast becoming the rule rather than the exception for patients with advanced melanoma we see at Georgetown-Lombardi,” Dr. Atkins said of Leta’s outcome.

Reflecting on Her Treatment and Looking Forward

Of her treatment, Leta recalled, “Choosing an NCI-designated Comprehensive Cancer Center like Georgetown Lombardi [one of 47 in the nation and the only one in Washington, D.C.] to receive my treatment was very beneficial when dealing with the latest therapies and in managing side effects. The various departments were aware of what to expect and knew how to successfully treat the side effects. It also made it easier for me to schedule appointments and avoid traveling to multiple facilities to receive care.”

And to others who may find themselves in a similar situation, she says to try not to rush into treatment immediately following a diagnosis; seek other opinions and ask lots of questions.

“Try to let loved ones help you,” she continued. “But allow yourself to handle this experience in a way that works best for you. Well-meaning friends wanted to sit with me through treatments, but that was a time for me to be alone and process my experience without feeling the need to put on a brave face. Say yes to offers that will ease your burden, and say no when you need to.”

To this day, she still has no evidence of the disease.

“I can’t believe how fortunate I am,” Leta said. “I’m looking forward to a really long life… it’s an incredible gift.”

Leta's full story can be viewed here:

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

The 2 Main Types of Non-melanoma Skin Cancer

The 2 Main Types of Non-melanoma Skin Cancer

Melanoma is the leading cause of death among skin cancer types, so it's understandable that it has become a major focus of the healthcare community. Non-melanoma skin cancers account for over 90 percent of all skin cancers in the United States, and while they are usually more easily managed, they can pose a serious problem if left unchecked.

The distinction between melanoma and non-melanoma skin cancer is important to discuss, as prognosis and management are different for each. Melanoma typically requires targeted therapy or immunotherapy, whereas surgical resection (a procedure to remove part of an organ or gland) and chemotherapy are more common approaches for non-melanoma skin cancer. Newer, targeted therapy approaches have also emerged for non-melanoma skin cancers.

What follows is an overview of the two most common types of non-melanoma skin cancer: basal cell carcinoma and squamous cell carcinoma.

Basal Cell Carcinoma

Basal cell carcinoma originates from cells called keratinocytes. When these cells become cancerous, they may form a localized lesion. The lesion usually appears hard and slightly raised, often with a pearly color and some vascular markings. If a patient presents a lesion of this kind, a biopsy should be performed to confirm the diagnosis.

Basal cell carcinoma is more common in patients who have been exposed to high levels of ultraviolet rays (such as tanning bed use or chronic sun damage), or in those who have compromised immune systems. The disease is fairly common and treatment is usually highly effective. The most common route is surgical excision; if the lesion is small and localized enough, a dermatologist or surgeon will be able to remove it with no further complications.

Cryotherapy and topical treatment are also options, but they are generally reserved for specific situations. For example, if a tumor grows too large for surgery or if it becomes metastatic (when cancer spreads to another part of the body), radiation or a combination of radiation and systemic therapy can be administered.

In the past, chemotherapy regimens, such as carboplatin and paclitaxel, have been offered to patients with unresectable, locally-advanced or metastatic basal cell carcinoma. Recent research has identified a critical pathway in most basal cell carcinoma tumors that can be blocked with targeted therapy. This is called the Hedgehog pathway (no specific relationship to hedgehogs) and the class of drugs are called smoothen (SMO) inhibitors. Vismodigib (Erivedge®) and sonidegib (Odomzo®) are the two FDA approved drugs. Both therapies can be very effective in treating basal carcinoma and have become standard practice.

It should be noted that, even with successful treatment, a case of basal cell carcinoma leaves one at a higher risk for further skin cancers. It is recommended to have regular medical checkups to monitor the condition of your skin.

Squamous Cell Carcinoma

Squamous cell carcinoma, like basal cell carcinoma, originates from keratinocytes, and its risk factors also include ultraviolet ray exposure and a compromised immune system. Lesions from squamous cell carcinoma can appear similar to those of basal cell carcinoma, but often they have a more flesh-colored, scaly and inflamed or irritated appearance. A biopsy is necessary to confirm a diagnosis.

Just as in basal cell carcinoma, surgical excision is the most common treatment option. It's usually cured by surgery alone and other local treatment options can be considered. Squamous cell carcinoma may invade and destroy surrounding tissue or spread to lymph nodes or distant organs if left untreated, so it's important to have any suspicious lesions examined.

In advanced cases, radiation and/or systemic therapy may be offered. Systemic therapy usually involves chemotherapy with regimens such as carboplatin and paclitaxel or capecitabine. However, newer approaches with EGFR targeted therapy and immunotherapy are showing great promise and can be considered.

Final Thought

Basal cell and squamous cell carcinomas are similar in their risk factors, treatment approaches and remission rates. Although they are not as lethal as melanoma, they are very common and are capable of doing significant damage and be deadly if left untreated. For that reason, screening is crucial for every patient, especially those with risk factors like sun exposure, a previous incidence of skin cancer or a compromised immune system.

When seeking treatment for skin cancers, it's often beneficial to hear a second opinion from a multidisciplinary clinic that involves a dermatologist, surgeons and medical oncologists. If you have a large or recurrent tumor that isn't amenable to surgery, there may be effective alternative approaches. Discuss this with your healthcare provider to make sure you are exploring every option available to you.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Warning Signs: Do You Know the ABCs of Melanoma Skin Cancer?

In the United States, skin cancers are diagnosed annually more than other cancers combined. Most are caused by over-exposure to ultraviolet (UV) rays, either by way of the sun or through man-made sources, such as tanning beds. In fact, according to the American Cancer Society, over 5 million cases of basal and squamous cell skin cancers are documented each year, and over 76,000 cases of melanoma - the deadliest form of skin cancer - are estimated to occur in 2016.

However, being aware of your skin and knowing the warning signs of melanoma to watch out for can go a long way toward increasing the likelihood of positive outcomes from treatment.

What Are the Warning Signs?

While many moles are harmless, you can conduct a simple self-examination of new moles or growths against a simple “A-B-C-D-E” checklist. If you have spot on your skin and are able to answer “Yes,” to any of the questions below, you should consult with a dermatologist and have a biopsy performed to see if the spot is, in fact melanoma.

  • Asymmetry
    Does one half of the mole not match the other?
  • Border
    Are the edges or borders blurred, irregular or notched?
  • Color
    Is the color not uniform across the growth? Does it include shades of brown or black, or patches of blue, pink, red or white?
  • Diameter
    Is the mole larger than 6mm - about the size of a pencil eraser?
  • Evolving
    Over time, does the growth change in color, shape or size?

That said, not all melanomas meet these criteria. So if you notice any changes in your skin - for example, a new growth that does not appear to match the others, or a change in a mole already present - contact an experienced dermatologist. Other symptoms of melanoma to be aware of include pigmentation spreading beyond the border of a growth, changes in surface texture or sensation, or sores that do not heal.

Prevention of Skin Cancers

Your skin is a vital organ that not only protects you from germs, but also your internal organs from injury. So remember, while it is important to be proactive about detection of melanoma or other skin cancers, you also should be proactive about preventing sun damage to your skin that increases the risk of skin cancer.

This is especially true in the summer months, where you may be spending more time outside having fun with friends and family. For example, apply and frequently reapply sunscreen, particularly if your skin burns easily. Also avoid being outdoors midday and in the early afternoon hours for long periods of time without some sort of protection, or the use of tanning beds.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.