Surgical advancements drive improved survival for patients with melanoma

March 31, 2023

The National Cancer Institute (NCI) estimated that 99,870 patients would be diagnosed with melanoma in 2022, making up 5.2% of all new cancer diagnoses. Advancements in screening and care have allowed care teams to catch melanoma earlier, when it's easier to treat. The NCI reports an overall steady increase in 5-year relative survival since 1975.

Tina J. Hieken, M.D., is a surgical oncologist at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, with a special interest in melanoma and breast cancer. She answers questions about the current state of melanoma care and advancements in the field that are rapidly being translated into the clinic.

Who does melanoma impact and how has that population changed over the years?

We have seen a shift over the last several decades to an increase in earlier stage disease diagnoses along with an overall increase in incidence of melanoma. Melanoma has historically been one of the most rapidly increasing cancers, but this has varied by age. In adults age 50 and older, rates continue to increase in women by about 1% a year but have stabilized in men. As the population ages, the average age at diagnosis of melanoma is closer to age 60; however, melanoma is one of the most common cancers in adults younger than age 30.

What are some important considerations specifically in early-stage melanoma?

Intercepting melanoma at its earliest stage gives us the opportunity to surgically treat the lesion in the skin without adding systemic therapies and potential toxicities to a patient's care plan. That being said, even the earliest stage disease requires an advanced and specialized care team to ensure that the treatments we choose are truly the best options for the patient.

At Mayo Clinic, our melanoma group is an interdisciplinary integrated clinical and research team including surgical, medical and radiation oncologists, as well as dermatologists, radiologists and pathologists. We also work closely with translational scientists to bring advancements into clinical practice as quickly as possible.

How has research advanced early-stage melanoma care in recent years?

At Mayo Clinic we are working in the laboratory and the clinic in several ways.

We have many open clinical trials in which we're applying new concepts to patient care. One example is enrolling patients with stage 1 and 2 melanoma to evaluate a clinical plus gene expression profile signature in those who are recommended for sentinel lymph node surgery.

We also are testing novel injectables for patients with more-advanced but surgically resectable disease in the soft tissue and lymph nodes. These new combinations of drugs can be given to patients who may have a high risk of disease recurrence following surgery.

Another area we are actively investigating is neoadjuvant systemic therapy for surgically resectable but high-risk disease. We have an open and enrolling investigator-initiated clinical trial testing novel combinatorial neoadjuvant immunotherapy regimens for patients with clinically evident melanoma in the regional lymph nodes.

How might surgical options help a patient with later stage melanoma?

While we typically think of surgery as an option primarily for early-stage disease, surgical oncologists are increasingly involved in the care of patients with advanced disease. Some patients have a mixed response to systemic treatment with limited resistant disease that can be removed with an operation. Surgeons also have a key role in tumor harvest for active immune cells as cellular therapies are tested in clinical trials and as we anticipate that these treatments will become approved for clinical practice in the near future. Surgical oncologists work with the multidisciplinary team to formulate the best possible treatment plan for each patient.

Ultimately, it's all about bringing all the right people into a patient's care team. When we work together, we can assess treatment response and make changes quickly if needed. We can move treatment options forward and provide the best options for patients with melanoma.

For more information

Cancer stat facts: Melanoma of the skin. National Cancer Institute.

Clinical trials: Melanoma research lymph node prediction implementation National_001 (MERLIN_001). Mayo Clinic.

Clinical trials: Neoadjuvant combination targeted and immunotherapy for patients with high-risk stage III melanoma. Mayo Clinic.

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