Melanoma

What is Skin Cancer?

Skin cancer is the most common form of cancer. There are several types of skin cancer, based on the type of cell in which the cancer starts. The most common types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The most aggressive types are melanoma (develops in the cells (melanocytes) that produce melanin) and Merkel cell carcinoma (rare, usually appears as a flesh-colored or bluish-red nodule, often on the face, head or neck).

A common risk factor for all skin cancers is exposure to ultraviolet light, which includes sun exposure as well as artificial sources, such as tanning beds. Exposure occurs over your lifetime and is cumulative. Other risk factors include:

  • weakened immune system
  • personal history of a prior skin cancer
  • skin cancer in the family
  • high mole count or “funny-looking” moles (for melanoma)

Diagnosis

Melanoma and other skin cancers are diagnosed by a skin biopsy. Pathologists specialized in evaluating the skin, dermatopathologists, examine a portion of the skin tissue, or tissue just beneath the skin, under a microscope, to assess for the presence of cancer cells. If present, additional features of the cancer are described to determine treatment and prognosis. If there is concern for spread of cancer, a biopsy of another part of the body may be necessary.

One or more of the following tools may be used to aid diagnosis of melanoma and other skin cancer:

  • Clinical examination. To look for other moles, birthmarks, or other areas that look abnormal in color, size, shape, or texture.
  • Blood testing. To measure the amounts of certain substances in the blood that may indicate the presence of cancer or organ dysfunction.
  • Radiographic studies (CT scan, PET/CT scan, MRI scan or X-ray). To evaluate for abnormalities with pictures of certain portions of the body.
  • Sentinel node biopsy. To locate, remove and examine the sentinel lymph node(s), the first lymph node(s) to which cancer cells are likely to spread from a primary tumor.

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Treatment

Indiana University Health Melvin and Bren Simon Cancer Center offers people with any stage of melanoma or other complicated skin cancers comprehensive diagnostic services, specialty consultations, treatments and clinical trials.

Our multidisciplinary team is composed of specialists in cutaneous oncology, including dermatologists, surgical, radiation, and medical oncologists, Mohs micrographic surgeons, plastic surgeons, dermatopathologists, otolaryngologists, neurosurgeons, and radiologists as well as dietitians, speech therapists, psychologists and social workers. Our multidisciplinary team convenes at a weekly tumor board conference to discuss cases and develop individualized treatment plans for patients.

Treatment options for patients with melanoma and other skin cancers include one or more of the following, based on the most current treatment recommendations, the stage of the cancer and needs of the patient:

  • Surgical excision. To remove the cancer as well as a border of surrounding healthy tissue. This is the most common treatment for melanoma and other advanced skin tumors. Depending upon the case, removal of lymph nodes and reconstruction such as skin grafting to replace the skin that is removed with skin from another part of the body, may be necessary. Isolated limb perfusion (treating an involved arm or leg with chemotherapy and heat directly into the blood vessels) is an additional specialized surgical procedure, which may be recommended..
  • Radiotherapy. Treatment that uses energy beams to kill cancer cells. This may be recommended in certain cases of melanoma and advanced skin tumors, to reduce the risk of recurrence of the cancer at a particular site. It may also be recommended in patients with advanced cancer to reduce pain or bleeding.
    • Stereotactic Body Radiation Therapy (SBRT) Used to precisely deliver a large radiation dose to a tumor and not to normal tissue.
    • Gamma-knife radiosurgery Specialized equipment aimed at a tumor from many angles in a single treatment session.
  • Systemic therapies. Medicines that are often indicated in more advanced melanoma and skin tumors. Different medicines work in different fashions to try and kill or control cancer cells.
  • Chemotherapies damage various parts of the cancer cell in an effort to kill the cells. Examples of chemotherapies used to treat melanoma include dacarbazine and temozolomide.
  • Immunotherapies try to re-educate the immune system to fight the cancer. In melanoma, interferon, high dose Interleukin-2, and ipilimumab are commonly recommended.
  • Molecularly targeted therapies attack various pathways in cancer cells to stop their functioning. Vemurafenib, a BRAF inhibitor, is a molecularly targeted therapy that may be indicated in advanced melanoma.

For patients with basal cell carcinoma – the most common type of skin cancer - or squamous cell carcinoma, IU Health Melvin and Bren Simon Cancer Center offers Mohs micrographic surgery.  This is a state-of-the-art skin cancer treatment that relies on the precision and accuracy of a microscope and immediate pathological examination of the tissue sample to trace out and ensure the removal of skin cancer down to its roots. This technique ensures that all the diseased tissue is removed, leaving healthy skin intact so that the Mohs surgeon, who is also trained in reconstructive surgery (repairing the wound), will be able to better repair the incision and minimize scarring.  Mohs micrographic surgery provides up to a 99 percent cure rate for these specific types of skin cancer.

Patients of the Melanoma Program are seen in consultation during a weekly interdisciplinary clinic and have access to the most advanced diagnostic and treatment options available. The IU Health Simon Cancer Center is at the forefront of cancer care discoveries and our patients have unique access to physician expertise diverse treatment options that include standard of care medicines as well as clinical trial options. Supportive care is also available through the CompleteLife Program whose staff compassionately support and educate our patients by tending to their emotional, mental, social and spiritual needs

Long-term follow-up is often necessary for melanoma and other advanced skin cancers and is determined and coordinated on a case-by-case basis.

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Physicians

Medical Oncology

Leslie Anne Fecher, M.D.
Theodore F. Logan, M.D.

Dermatology and Dermatologic Surgery

Lawrence A. Mark, M.D., Ph.D.
Ally Khan-Somani, MD, Ph.D

Surgical Oncology

Douglas Schwartzentruber, M.D.

Plastic and Reconstructive Surgery

John J. Coleman, M.D.
William Wooden, M.D

Radiation Oncology

Mark Langer, M.D.

Mohs Surgery

Ally Khan-Somani, MD, Ph.D

Dermatopathology

Simon Warren, M.D.

Melanoma Nurse Coordinators

Lisa Freestone, RN

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Research

IU Health Simon Cancer Center is at the forefront of cancer care discoveries. Information about cancer research can be found here.

Clinical Trials

If you qualify, you may be able to join leading edge clinical trials.

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