Hello, I’m Dr Andrew Dean, a medical oncologist from Perth in Western Australia and I’d like to talk to you today about melanoma.
Currently the best treatment for a melanoma that’s actually formed is surgical, i.e. it needs to be excised with a reasonable margin around the edge. We call this a wide local excision. Depending on the type of melanoma and the depth of invasion, the person who removes the melanoma may also recommend something called a sentinel lymph node biopsy, where the lymph node which drains the skin where the melanoma appears can actually be taken out to see if any of the melanoma cells have spread to the lymph node.
If melanoma has spread to just one lymph node and the rest of the scans are clear, showing no involvement of organs or other lymph nodes, the primary treatment is still surgical and a lymph node clearance will often be carried out.
Currently in Australia, for melanomas that have spread to lymph nodes only, that have then been surgically removed, the approved treatment by the government, is treatment with interferon, which involves a month of intravenous injections with an immune system boosting drug call interferon, followed by a year of sub-cutaneous interferon injections three times weekly. This has been shown to improve the cure rate by a small but significant amount, in people whose melanoma has spread to lymph nodes.
There’s a growing interest in some of the newer immune therapies such as ipilimumab and nivolumab which are drugs that stimulate the immune system to go hunting out abnormal, rogue melanoma cells. Trials have been conducted which are showing significant benefits but at the cost of some side effects.
People often ask, if they’ve been diagnosed with melanoma, “Is there a clinical trial for me?” and the answer is now that most melanoma centres have trials for patients with both early melanoma and late melanoma and I urge you to discuss this with your treating doctor, as to whether there’s a suitable trial available that might give you availability for one of these newer treatments.
One of the most exciting changes in oncology over the last ten years has been the development of bigger, better, newer immune therapies for metastatic melanoma, i.e. melanoma that’s spread to other parts of the body. We’ve always known that melanoma can respond to immune therapies because of the success with drugs such as interferon and interleukin.
The newer immune therapies such as ipilimumab or Yervoy are antibodies which specifically activate the body’s own defence mechanisms. Ipilimumab is given as an intravenous infusion every three weeks for four doses and can take a number of months before it actually works.
Ipilimumab stimulates the body’s immune system to attack melanoma cells but in doing so it can also attack some of the body’s own tissues. It’s a bit like revving up the immune system so much that the immune system can get a bit over-activated. And if so it causes a few specific problems. One of these is inflammation of the bowel where the bowel becomes inflamed, the symptoms being diarrhoea, which can progress to diarrhoea, blood and mucus.
I should stress that this only happens in a very small proportion of people and if it happens your doctor who is treating you with ipilimumab will know how to manage these symptoms. But it is imperative that you alert you doctor if you get any of these side effects.
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