This serious form of skin cancer often requires additional treatment.
In some cases, skin cancer can be one of the simplest types of cancer to treat. Because the skin is an external organ, some skin cancer tumors can be cut out with surgical excision, a minor outpatient procedure that only requires local anesthesia.
Melanoma, however, is different: Unlike other types of skin cancer, melanoma is more likely to spread (metastasize) to nearby lymph nodes and affect other parts of the body. Because of melanoma’s aggressive nature, additional treatments besides surgical excision are often necessary. These secondary treatments are known as adjuvant therapies.
Melanoma is the rarest, yet most dangerous, type of skin cancer, according to the Skin Cancer Foundation. It is typically caused by intense UV exposure caused by sunlight or tanning beds, resulting in tumors in the melanocytes (cells that produce pigment) of the skin. Learn more about what melanoma is here.
Criteria for Adjuvant Therapy for Melanoma
To treat melanoma, doctors will assess the spread of the cancer cells. If the melanoma has not appeared to spread to nearby lymph nodes and the melanoma has a low risk of metastasis, surgical excision may be all that’s necessary. This is usually the case for thin melanomas that are caught early.
However, if the melanoma is marked as moderate to high risk of metastasis, adjuvant therapies will be used after surgical excision of the melanoma. To be considered a higher risk of spreading to lymph nodes and other organs, the melanoma will have one or both of the following characteristics:
Is thicker than 0.8 millimeters
And/or is ulcerated, meaning it is open and bleeding.
If the melanoma has these characteristics, adjuvant therapy will likely be used. The goals of adjuvant therapy for melanoma are to destroy cancer cells that have spread to other organs and to reduce the likelihood for melanoma recurrence.
Types of Adjuvant Therapy for Melanoma
After surgically cutting out the melanoma, doctors turn to standard cancer treatments for adjuvant therapy. The following treatments are the most common adjuvant therapies used to treat metastatic melanoma:
A type of immunotherapy known as checkpoint inhibitors, which help the immune system distinguish between cancer cells and normal, healthy cells
Targeted therapy, which attacks cells that have specific proteins associated with cancerous gene mutation
Although melanoma can be serious, newer adjuvant therapies are making treatment more effective and may improve prognosis. Learn more about how immunotherapy has revolutionized melanoma treatment here.
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If you look in the blood of
patients with stage three melanoma,
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surgically free of disease,
there's no visible tumor.
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Half of them at least or more,
you would detect circulating tumor cells.
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they're just waiting to pounce, grow.
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The immune system is barely holding
them in check, and if something happens
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to make them just go over the edge,
all of a sudden those tumors will grow.
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And I think most people,
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if they had a reasonable thing they could
do that would cut that risk in half.
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Which is basically the risk reduction
with the adjuvant therapies,
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they would do the adjuvant therapies.
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Adjuvant therapy is treatment that's added
to surgery after the surgeon does his or
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When they remove the tumor,
clinically it's gone.
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But we all know that melanoma,
depending on how thick it is and
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how many different qualities it has,
can have a very high risk of relapse,
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even after the surgeon takes it out.
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In adjuvant melanoma therapy,
we tend to give immunotherapy first.
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And then if you fail the immunotherapy,
you develop a new tumor that can
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be surgically removed to
render you free of disease.
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That's when you give the targeted therapy.
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There are actually multiple
adjuvant therapies approved.
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There are two targeted drugs that
are approved for adjuvant therapy.
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And there are at at least three, and there
will be very soon four immunologic drugs
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that are approved as adjuvent therapy.
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And all of the adjuvant regimens, almost
arbitrarily, are given for 12 months.
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When you think about it, if you're
a patient, 12 months of treatment,
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either every two weeks or
every four weeks or every three weeks.
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Whatever the schedule,
that's about as much as you want to do.
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95% of all the relapses will have
occurred by year five, and at year five,
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you feel like you're pretty
close to being out of the woods.
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And you've just got to go about your life.
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Not worrying that, my God, is the melanoma
going to come back at year eight?
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So I tell patients, go out,
glass of champagne, celebrate.
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You got to year six, you're free
of disease, feel good about that,
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we're going to stop scanning you.
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Adjuvant therapy for cutaneous melanoma. Waltham, MA: UpToDate, 2018. (Accessed on February 11, 2019 at https://www.uptodate.com/contents/adjuvant-therapy-for-cutaneous-melanoma.)
Immune checkpoint inhibitors to treat cancer. Atlanta, GA: American Cancer Society, 2018. (Accessed on February 11, 2019 at https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html.)
Immunotherapy for melanoma skin cancer. Atlanta, GA: American Cancer Society, 2016. (Accessed on February 11, 2019 at https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html.)
Melanoma treatments. New York, NY: Skin Cancer Foundation. (Accessed on February 11, 2019 at https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-treatments.)
Targeted therapy for melanoma skin cancer. Atlanta, GA: American Cancer Society, 2018. (Accessed on February 11, 2019 at https://www.cancer.org/cancer/melanoma-skin-cancer/treating/targeted-therapy.html.)
What is melanoma? New York, NY: Skin Cancer Foundation. (Accessed on February 11, 2019 at https://www.skincancer.org/skin-cancer-information/melanoma.)