An NCI-designated Comprehensive Cancer Center
By Kevin Chesley | July 26, 2018
Skin cancer is the most common kind of cancer. It takes many forms, but even melanoma — the rarest, most aggressive form — has a nearly 100 percent cure rate, especially if caught and treated early.
Kim Margolin, MD, clinical professor in the Department of Medical Oncology & Therapeutics Research at City of Hope, specializes in melanoma.

Discovering and Diagnosing Melanoma

Melanoma is often first noticed as a mole or dark spot, but many such spots aren’t melanoma. Margolin explains how professionals check further: “Dermatologists distinguish the features between melanomas and benign skin lesions, and biopsy anything suspicious. We use the ABCDE system: A for asymmetric, B for border irregularity, C for color variation, D for a diameter larger than six millimeters and E for evolution, meaning a change in an existing mole or the appearance of an unusually dark spot where there was none before.”
A surgical method is sometimes employed for diagnosis as well. “Depending on the size, shape and location of the lesion, it may be biopsied with a shave device to take off the top part,” Margolin says. “It’s not recommended for lesions highly suspected to be melanoma because we don’t want to cut through a tumor.”

Treatments for Melanoma

Once a diagnosis of melanoma is made, Margolin and her team jump into action. “The first line of defense is surgery. The patient has an area of skin resected or removed. The margin around the active cancer takes into account that isolated cancer cells can move from the primary site into the local skin. If you cut a wide enough area, you give the patient a very reduced chance that it will recur locally,” she says.
Beyond removing the growth with wide margins, further surgery may be needed, including removal of lymph nodes. “Depending on the depth and thickness of the legion — measured in millimeters — we may explore the nearby lymph nodes,” Margolin says. “For example, if it were on the arm, it would be the lymph nodes in the armpit. Cancer there would indicate a higher risk of recurrence. Then we give medications to reduce that chance, often immunologically oriented interventions that stimulate the body’s own immune system such as the white blood cells. These kill any circulating tumor cells. More work must be done here because melanoma is quite difficult to treat when it has spread.”

The Targeted Possibilities

When the circumstances are just right, targeted therapy is a new possibility. “When melanoma is advanced, when it has spread, targeted therapy is the answer,” Margolin says. “This is especially the case if the patient’s melanoma demonstrates selected mutations that may lead to the hyperactivation of certain pathways in the melanoma cell. There are drugs for those pathways that block them and cause remission in patients whose tumors are driven by those mutations, which occur in half of all melanoma patients.”

The Hope For Remission

Once a patient has undergone some of these treatments, there is still always the risk of relapse — but there is always hope as well. “It’s hard to guarantee that someone will stay in remission until we can look back and see that they’ve been in remission for a long time,” Margolin says. “The longer somebody has been in remission, the higher the chances they will stay there. Because of recent huge breakthroughs in therapy, we don’t really have data yet as to how long remissions last and how many patients might be actually cured. I try to put all of my patients in clinical trials as much as possible. We’re going to have better answers with longer-term follow-up of these therapies. There is very little City of Hope can’t do.”
Learn more about melanoma and skin cancer. If you are looking for a second opinion about your melanoma diagnosis or consultation about your treatment, request an appointment online  or contact us at 800-826-4673.

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