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Melanoma diagnoses are increasing at epidemic rates. It is the deadliest form of skin cancer and it is believed that every hour of every day, one American dies from melanoma. In 2018, over 178,000 people are expected to be diagnosed.
I had the opportunity to ask Dr. Trevan D. Fischer some thought provoking questions about melanoma cancer and the answers are listed below. One big way that we can make a difference in eradicating cancer is by sharing true facts and information.
Trevan D. Fischer is an Assistant Professor of Surgical Oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center. He is the Assistant Program Director of the Complex Surgical Oncology Fellowship program at JWCI. Dr. Fischer began his medical training at the University of Oklahoma for both medical school and his undergraduate work.
Prior to becoming a Surgical Oncologist, he completed his General Surgery residency at the University of Florida. In 2015, he came to the John Wayne Cancer Institute as a Complex General Surgical Oncology Fellow and transitioned to faculty after graduation. More here
1. What is melanoma?
Melanoma is a dangerous type of skin cancer. The cells that give our skin pigmentation, known as melanocytes, can be damaged through UV radiation and other factors. This type of skin cancer is dangerous because unlike the more common skin cancers, melanoma has a higher potential to spread throughout the body.
2. How is it diagnosed?
Melanoma is diagnosed by a simple skin exam done by your physician. If your doctor has a high level of suspicion, they will take a biopsy. The two most common types of biopsies are a shave biopsy and a punch biopsy. This specimen is then sent to a pathologist who reviews the lesion under the microscope.
3. What are the signs or symptoms?
Asymmetry of the lesion
Borders – uneven or irregular margins around the lesion
Color variation – within the lesion different shades of black, brown or even red
Diameter – usually greater than 6 mm (approximately the size of a pencil eraser)
Evolution – changes that occur in shape, size or color
4. What is the standard treatment plan?
When melanoma is diagnosed early, surgery to remove the lesion, called a wide local excision, is routinely done first. Your surgeon will also discuss the need to remove the sentinel lymph node or nodes as well.
If the melanoma has spread to the lymph nodes or to other sites of the body, we now offer treatment options that are very effective. Immunotherapy is widely used in this clinically scenario. This type of therapy unlocks the brakes of the immune system and allows your body’s defense system to kill the cancer cells.
5. Are there targeted therapies?
Yes, many new therapies are now available for patients with more advanced stages of melanoma. One of these targeted therapies is called BRAF/MEK inhibitors. This oral pill targets a specific mutation that occurs in some patients with melanoma.
6. What is metastatic melanoma?
When the cancer spreads outside the primary site, it is considered metastatic. Melanoma typically spreads to the lymph nodes first and from there, it can spread to other lymph nodes or other systems of the body.
7. Is there genetic testing that can be done to determine if you are predisposed?
There are rare genetic conditions that predispose one to melanoma. Only around 10% of patients with melanoma have a known hereditary component. CDKN2A is one of the common mutations seen with hereditary melanoma.
8. What are your thoughts on over the counter testing kits?
Melanoma should be cared for by those who specialize in the treatment of this deadly disease. Early diagnosis is key in improving long term survival. Any over the counter test commercially available should not be substituted for care by a dermatologist and surgeon.
9. What type of support is available for patients/caregivers?
We feel that support for patients and their caregivers is very important. The John Wayne Cancer Institute at Providence Saint John’s Health Center offers a survivorship program which includes a Nurse Practitioner and a team of social workers, genetics counselors, nutritionists, and other experts that provide a wide variety of care. Learn more by visiting our cancer support page: https://www.saintjohnscancer.org/cancer-support/
We also refer many of our patients to the Cancer Support Community Los Angeles (http://cancersupportla.org/) for free services and events.
10. What types of clinical trials are being conduct and how does one qualify to participate?
Numerous ongoing trials are actively recruited at the John Wayne Cancer Institute. Most trials are using the new immune oncology drugs in combinations with novel therapies. Each trial has different inclusion and exclusion criteria. Scheduling an appointment with our team is the easiest way to determine if any clinical trial is in your best interest. A full list of active trials are listed on our website: https://www.saintjohnscancer.org/clinical-trials/