Melanoma 101

Melanoma is a type of skin cancer. It’s less common than the other two major forms of skin cancer, which are called basal cell carcinoma and squamous cell carcinoma. However, melanoma is more likely than other skin cancers to spread throughout the body, which makes it the most serious form. Other names your doctor may use for this cancer include malignant melanoma and cutaneous melanoma.

What is Melanoma?

Melanoma begins in melanocytes, which are cells found in the deep layers of your skin. Melanocytes produce a pigment called melanin that gives skin its color. When you are exposed to the sun’s ultraviolet (UV) rays or any other source of UV (such as a tanning bed), melanocytes step up production of melanin, which protects the skin and causes it to darken. However, exposure to UV rays can damage the DNA of melanocytes and cause them to grow uncontrollably. Having certain gene mutations may make you more likely to develop melanoma.

Melanoma commonly occurs on parts of the body that get the most sun exposure, including the face, neck, chest, back, arms, and legs. However, melanoma can arise on any part of the body. While uncommon, melanoma can even affect the eyes or genitals.

What Are the Types of Melanoma?

There are four main types of melanomas. They include:

• Superficial spreading melanoma: The most common form of melanoma grows slowly at first, but can penetrate deep into the skin over time. It’s more common in people with very fair skin who experience damage from UV rays. Certain gene mutations have been linked to superficial spreading melanoma.
• Nodular melanoma: This form of melanoma, the second most common, can start out appearing to be a blood blister or bump on the skin. It’s also caused by UV damage and is fast growing.
• Lentigo maligna melanoma: A slow-growing form of skin cancer, lentigo maligna melanoma is most common in older people whose skin is heavily damaged from UV exposure and typically occurs on the face, scalp, or neck.
• Acral lentiginous melanoma: Although rare overall, acral lentiginous melanoma is the most common form of melanoma in people of African and Asian descent. It develops on the palms of the hands, soles of the feet, and under toenails and fingernails. This slow-growing form of melanoma is not related to exposure to UV rays.

Doctors determine which type of melanoma a patient has by viewing a sample of skin cells under a microscope. Identifying the melanoma type is important for giving the patient a prognosis and deciding on a treatment plan.

How Does Melanoma Differ From Other Types of Skin Cancer?

Melanoma differs from the two other major forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, in three key ways:

• Location: The visible part of your skin, called the epidermis, is where squamous cell carcinoma forms. Basal cell carcinoma develops in the lower portion of the epidermis, that is, the part you can’t see. Melanoma arises from cells deeper in the skin.
• Frequency: Basal cell carcinoma and squamous cell carcinoma are far more common than melanoma.
• Chance of spreading: Basal cell carcinoma and squamous cell carcinoma rarely spread, or metastasize (though they still require treatment). Melanoma can spread to other parts of the body rapidly if it’s not detected and treated promptly.

What Are the Most Common Treatments for Melanoma?

The melanoma treatment plan your doctor recommends will depend on several factors, including the size (or depth) of the tumor, and whether the malignancy was detected early, before it could spread, or whether the cancer cells have migrated elsewhere in your body. Here is a brief summary of the various treatments for melanoma.

Surgery: Surgical removal of a tumor is the primary treatment for melanoma. When detected early, before melanoma has spread, surgery may be the only treatment needed. The most common surgery for melanoma is called wide excision, in which a surgeon uses a scalpel to remove the tumor, as well as some healthy-appearing tissue surrounding the tumor (known as a margin). A doctor then views the margin under a microscope. If no cancer cells are present, the surgery is complete. If cancer cells are detected, the surgeon will remove more tissue and repeat the process until healthy-appearing tissue has no evidence of cancer. This surgery usually leaves a scar. In some cases, melanoma may be treated with a technique called Mohs surgery, which often leaves a less-noticeable scar. However, Mohs surgery is only appropriate for some melanoma patients.

If melanoma has spread, surgery is unlikely to cure the disease. However, a doctor may recommend surgical removal of metastatic melanoma to alleviate symptoms it may be causing.

Chemotherapy: Chemotherapy uses drugs that kill malignant cells or prevent them from dividing and making copies of themselves so that a tumor can grow and spread. Chemotherapy is sometimes administered after surgery to decrease the likelihood that the cancer will return, which is known as adjuvant therapy. However, chemotherapy is no longer offered to melanoma patients as often as in the past, since new medications that are more effective and less toxic have become available.

Radiation Therapy: While most melanoma patients do not require radiation therapy, it can play a role in some cases. Radiation therapy uses high-energy invisible beams to kill cancer cells. The most common form used in cancer therapy is called external beam radiation therapy, which is delivered from outside the body. In some cases, other forms of radiation therapy are used.

Immunotherapy: Your body has a natural defense network called the immune system. The purpose of immunotherapy is to strengthen the immune system and make it better able to fight cancer, including melanoma that can’t be cured by surgery. There are several forms of immunotherapy available for treating melanoma, including innovative new medicines called checkpoint inhibitors, which prevent cancer cells from “hiding” from the immune system.

Targeted Therapy: Scientists have identified several gene mutations, or alterations, that appear to play a role in causing melanoma cells to grow uncontrollably, form tumors, and spread. A targeted therapy is designed to identify and attack cancer cells that have these genetic mutations. Because these cutting-edge treatments are designed to strike only a specific target, they may be less likely than chemotherapy to harm healthy tissue and cause side effects. Targeted therapies for melanoma zero in on the following genes: BRAF, MEK, and C-KIT.

Clinical Trials

If you have melanoma that can’t be treated by surgery, it’s important to consider all of your treatment options. That includes participating in a clinical trial, in which researchers evaluate the benefits and safety of new, potentially life-saving therapies. Massive Bio’s artificial intelligence-powered platform, SYNERGY-AI, scans thousands of clinical studies in seconds to identify clinical trials that are recruiting patients like you. If you’re interested in enrolling in a clinical trial, contact Massive Bio today.

Sources: American Cancer Society, Genetic and Rare Diseases Information Center, Medline Plus, Memorial Sloan Kettering Cancer Center, National Cancer Institute

How Common is Melanoma?

Melanoma makes up about one percent of all skin cancers, making it far less common than the other two major forms, basal cell carcinoma and squamous cell carcinoma. However, melanoma is more serious than the other two primary types of skin cancer.

Over 1.3 million people in the United States have melanoma. The American Cancer Society (ACS) estimates that about 97,610 new cases of melanoma will be diagnosed in the United States in 2023. An estimated 7,990 people will die of the disease.

Around the world, nearly 325,000 people were diagnosed with melanoma in 2020 and slightly more than 57,000 people died of the disease, according to the World Cancer Research Fund International.

Who Gets Melanoma?

Men are more likely than women to develop melanoma. In the United States, roughly 58,120 males and 39,490 females will be diagnosed with this skin cancer this year.

White people develop melanoma far more often than Black people do. By one estimate, white Americans are 20 times more likely than Black Americans to get melanoma; the latter have a roughly one in 1,000 chance of being diagnosed. Rates among Asians and Pacific Islanders are nearly as low. Among Hispanic and Native American people, the odds are slightly higher, around one in 167.

The risk for melanoma grows as you age. The typical new patient is 65. However, this serious form of skin cancer can strike much earlier in life. In fact, melanoma is one of the most common cancers in young people, according to the ACS. Even kids can get melanoma—about 400 are diagnosed with this type of skin cancer in the United States each year.

The top 10 countries with the most annual cases of melanoma are (in order):

1. Australia
2. New Zealand
3. Denmark
4. The Netherlands
5. Norway
6. Sweden
7. Switzerland
8. Germany
9. Slovenia
10. Finland

What Are the Trends in Melanoma Incidence and Survival?

After rising for years, the incidence of melanoma in the United States began dropping within some groups in the mid 2000s, decreasing by about one percent per year among people under 50. Growing awareness about the harm of the sun’s ultraviolet rays is credited with reducing melanoma in this group. However, rates appear to be increasing among older men and women. Deaths from melanoma have decreased across all ages, too. A 2020 study found that deaths from melanoma decreased 18 percent among white people between 2013 and 2016. Doctors credit the availability of better treatments with saving lives.

Sources: American Cancer Society, American Academy of Dermatology, American Society of Clinical Oncology, Centers for Disease Control and Prevention, Melanoma Research Foundation, World Cancer Research Fund International

Melanoma Symptoms and Signs

Melanoma can be mistaken for a common mole and other less-concerning skin changes. Here are some skin changes that could be signs of melanoma, which should be checked by a doctor:

• A mole that changes shape, grows, or develops redness around its edges.
• A new mole or other spot on your body that looks nothing like other skin spots.
• A spot with a jagged border.
• A spot that is multicolored.
• A raised growth that’s firm to the touch, with the appearance of a blood blister (often called nodular melanoma).
• Changes to toe- or fingernails, such as dark-brown or black vertical lines or bands of darkened skin around the nail.
• Thickened, scar-like patches that grow slowly.

The Melanoma ABCDE’s

Another way to spot melanoma is to apply the ABCDE rule, which dermatologists created to help people spot possible melanoma early, when it responds best to treatment and before it spreads to other parts of the body. See a doctor soon if a mole or other spot on your body has any of the following features:

• Asymmetry: Instead of being uniform in shape or appearance, one half of the spot doesn’t match the other.
• Border: The edges of the spot aren’t smooth; instead, they appear jagged, notched, or blurred.
• Color: A spot that is more than one color, such as brown and black, could be melanoma. These skin cancers can also appear pink, red, white, and even blue.
• Diameter: A melanoma mole is usually more than ¼ inch wide (think of a pencil eraser), though they can be smaller, so don’t rule out melanoma based on side of the spot alone.
• Evolving: A spot that has changed in any way over time needs to be evaluated.

Sources: American Cancer Society, American Academy of Dermatology

Melanoma Diagnosis

A melanoma diagnosis usually starts with a patient or doctor suspecting that a skin spot could be cancer. In addition to performing an overall physical exam and taking the patient’s medical history (including asking whether any close relatives have had skin cancer), a doctor will remove a skin sample, which can usually be performed in the exam room. This sample will be sent to a lab for testing. If melanoma is detected, further testing is likely necessary. Not all patients require each of the tests described here, but some may be necessary to learn more about a patient’s melanoma and determine the most effective treatment.

What Tests Are Used To Diagnose Melanoma?

A primary care doctor or dermatologist (a doctor who treats skin disorders) may suspect that a spot on your skin is melanoma or another form of skin cancer if it meets certain criteria. For example, an existing skin mole that changes shape or color could be a sign of melanoma. Moles that are large, asymmetrical, or have jagged edges are causes for suspicion, too. The same is true of a new mole or spot that doesn’t resemble any other on your skin. When examining a suspicious skin spot, a doctor may use a special handheld light called a dermascope to get a better view.

If your primary care doctor is concerned about a spot on your skin, he or she will likely refer you to a dermatologist. If the dermatologist agrees that the spot requires further evaluation, he or she will use one or more of the following tests.

Skin Biopsy

In a skin biopsy, a doctor uses one of several different tools to remove all or a portion of a suspicious spot (which your doctor may call a lesion). This tissue specimen is sent to a lab for evaluation by a doctor called a pathologist.

To prepare you for a biopsy, the doctor will inject anesthetic to numb the area to be examined, which may cause a brief pinching or burning sensation. Next, the doctor removes tissue using one of several different techniques:

• Shave biopsy: Using a tool that looks like a mini version of a razor used for shaving beards or legs, a doctor removes just the top layer of skin. Also called a tangential biopsy.
• Punch biopsy: If a doctor decides it’s necessary to remove deeper layers of skin, he or she will use a tube-shaped tool that works something like a cookie cutter to perform a punch biopsy.
• Excisional biopsy: If a doctor needs to probe even deeper to remove tissue, he or she will use a scalpel or similar blade. If the doctor is unable to remove the entire growth, the process is called an incisional biopsy.

When the biopsy is complete, the doctor treats the skin to stop bleeding. In some cases, stitches may be necessary. After applying petroleum jelly, the wound is bandaged. Biopsies usually leave at least a small scar. (Some dermatologists have begun using alternative skin biopsies that can eliminate the need for some cutting, including optical biopsies and adhesive patch testing.)

A skin biopsy specimen is then sent to a lab, where a pathologist studies it under a microscope. The pathologist will produce a report that determines whether the removed tissue is melanoma or any other type of skin cancer. If it turns out to be melanoma, the report will include details about the tumor that will help the dermatologist determine the patient’s prognosis (or the most likely outcome) and the best course of treatment, including:

• The tumor’s thickness. Some are thin, while others are deeper. Tumor thickness is an important factor for predicting whether melanoma will spread and require more-aggressive treatment.
• How fast the cells are growing, known as mitotic rate.
• Ulceration, or loss of skin over the tumor.
• The type and subtype of melanoma.

In some cases, biopsy specimens will also be sent for genetic testing. Scientists have linked certain gene mutations, or alterations, to melanoma. Notably, about half of melanoma patients have a mutation in the BRAF gene. Other genetic mutations may also play a role in melanoma. Certain treatments for advanced melanoma, known as targeted therapies, work best in people with specific gene mutations, so knowing whether you have one or more is essential for developing your treatment plan.

What Tests Are Used if I Have Melanoma?

If a skin biopsy indicates that you have melanoma, your doctor will use additional tests to determine the cancer’s stage, or extent of the disease. They may include:

Imaging Tests

If your biopsy results suggest that a melanoma lesion may have spread, your doctor will likely order imaging tests. Various types of imaging tests are used to detect whether melanoma has spread, or metastasized, including computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and X-rays.

Lymph Node Biopsy

Lymph nodes are small structures in the immune system that filter fluid called lymph, which carries immune cells that protect the body against infection and disease. When cancer cells are detected in the lymph nodes it’s a sign that a cancer such as melanoma has spread. Doctors have several methods for examining lymph nodes for sign of cancer, including:

• Fine needle aspiration biopsy, in which a doctor numbs the patient’s skin with local anesthetic, then inserts thin syringe into the body to remove a tissue specimen from a lymph node.
• Surgical lymph node biopsy, a procedure that may require the patient to be sedated and involves removing a lymph node with a scalpel.
• Sentinel lymph node is a surgical procedure in which a harmless radioactive substance and blue dye are injected into the patient, then a doctor uses a special camera to determine if they have collected in the sentinel lymph nodes, which are the ones a metastasizing melanoma would spread to first. If the dye is detected in sentinel lymph nodes, that indicates the presence of melanoma cells, which means the cancer has spread.

Blood Tests

Your doctor may check your blood levels of a substance called lactate dehydrogenase (LDH) to help determine your prognosis. Elevated LDH often indicates that melanoma has spread and needs aggressive treatment. Your doctor may use other blood tests as part of your melanoma diagnosis.

Sources: American Cancer Society, American Society of Clinical Oncology

Melanoma Staging

Doctors use a system called staging to describe the extent of a patient’s cancer. A melanoma’s stage is determined by the size and depth of a tumor, and whether it has spread. Cancer staging plays an important role in deciding what treatment is best for a patient.

To stage melanoma, a doctor first gathers as much information as possible about the patient and his or her malignancy. Key clinical tests that a doctor uses to stage melanoma include:

• Skin biopsy, in which a small piece of tissue is removed from a suspicious spot and tested for the presence of cancer cells in a lab.
• Imaging, which may include computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, or X-rays.
• Lymph node biopsy, which involves removal of one or more of these structures, which are part of the immune system, to inspect for the presence of cancer cells that migrated away from the tumor.

Doctors use the results of these tests when applying the criteria of the standard system for staging melanoma, known as the American Joint Committee on Cancer (AJCC) TNM system.

• T is for tumor: How thick is the tumor? And has it ulcerated, that is, has the skin on top broken down?
• N is for node: Has the cancer spread to nearby lymph nodes?
• M is for metastasis: Has the cancer metastasized or spread to distant lymph nodes or other body parts?

Using these criteria, a doctor will assign a stage to a melanoma using a number (often a roman numeral) from 0 to IV; the higher the number, the more serious the cancer. The melanoma staging system also uses the letters A, B, C, and D to describe degrees of seriousness within each number.

The stages of melanoma are as follows:

• Stage 0: At this very early stage, cancer cells are found only in the epidermis, the outer layer of skin, and have not penetrated deeper layers. The cancer has not spread. Also called melanoma in situ.
• Stage I: The tumor is no more 2 millimeters thick, which is about .08 inches. The skin may or may not be ulcerated (or broken). The cancer has not spread.
  • Stage IA: The tumor is less than 1 millimeter thick and may or may not be ulcerated.
  • Stage IB: The tumor is between 1 millimeter and 2 millimeters thick and is not ulcerated.
• Stage II: The tumor is at least 1 millimeter thick, and may be thicker than 4 millimeters, and extends into the deeper dermis layer of the skin. The tumor may or may not be ulcerated. The cancer has not spread.
  • Stage IIA: The tumor is between 1 millimeter and 2 millimeters thick and is ulcerated OR it’s between 2 millimeters and 4 millimeters without ulceration.
  • Stage IIB: The tumor is between 2 millimeters and 4 millimeters thick and is ulcerated OR it’s more than 4 millimeters this and is not ulcerated.
  • Stage IIC: The tumor is more than 4 millimeters thick and ulcerated.

• Stage III: These cancers are called regional melanoma, meaning that they have spread to nearby lymph nodes, skin, or other tissues, but not distantly throughout the body. There are several categories of stage III melanomas:
  • Stage IIIA: The tumor is no more than 2 millimeters thick and may or may not be ulcerated. The cancer has spread to up to three nearby lymph nodes, but not to other parts of the body.
  • Stage IIIB: The original tumor is no longer visible, but the cancer has spread to one lymph node OR skin or tissues called skin lymphatic channels near the tumor OR the tumor is up to 4 millimeters thick, may or may not be ulcerated and the cancer has spread to one lymph node OR skin or skin lymphatic channels near the tumor OR to two or three nearby lymph nodes.
  • Stage IIIC: The tumor has spread to nearby lymph nodes, skin, or tissues called skin lymphatic channels, but has not spread to other parts of the body. Doctors break down stage IIIC melanoma into several subcategories, based on criteria such as whether the original tumor is still visible, the thickness of the tumor, whether the tumor is ulcerated, the number of lymph nodes the cancer has spread to, whether the infiltrated lymph nodes are grouped together, and whether the cancer has spread to skin or skin lymphatic channels near the tumor.
  • Stage IIID: The tumor is thicker than 4 millimeters and ulcerated. Doctors break down stage IIID melanomas into subcategories using various criteria, such as whether the cancer has spread to four or more nearby lymph nodes, lymph nodes that are grouped together, or to skin or skin lymphatic channels near the tumor.
• Stage IV: The cancer has spread to other parts of the body, such as the lungs, gastrointestinal tract, or brain, or to other parts of the skin. The size of the tumor, ulceration status, and presence of cancer in the lymph nodes are not considered.

American Cancer Society

Melanoma Treatment Options

The melanoma treatment plan your doctor recommends will depend on several factors, including the size (or depth) of the tumor, and whether the malignancy was detected early, before it could spread, or whether the cancer cells have migrated elsewhere in your body. Here are the various treatments for melanoma that your doctor may discuss with you.

Surgery

Surgical removal of a tumor is the primary treatment for melanoma. When detected early, before melanoma has spread, surgery may be the only treatment needed. The most common surgery for melanoma is called wide excision, in which a surgeon uses a scalpel to remove the tumor, as well as some healthy-appearing tissue surrounding the tumor (known as a margin). A doctor then views the margin under a microscope. If no cancer cells are present, the surgery is complete. If cancer cells are detected, the surgeon will remove more tissue and repeat the process until healthy-appearing tissue has no evidence of cancer. This surgery usually leaves a scar.

As an alternative, a doctor may treat a melanoma with an approach known as Mohs surgery. In this procedure, a specially trained surgeon removes a very thin layer of skin and tumor, then studies it under a microscope. If cancer cells are found, another thin layer of tissue is removed and studied. This process is repeated until no cancer cells can be detected. One advantage of Mohs surgery is that it often leaves a less-noticeable scar. However, Mohs surgery is only appropriate for some cases of melanoma.

If cancer is detected in the lymph nodes, they will be removed in a surgery known as a lymphadenectomy. If the cancer has spread, known as metastatic melanoma, surgery is unlikely to cure the disease. However, a doctor may recommend surgical removal of metastatic melanoma to alleviate symptoms it may be causing.

Chemotherapy

Chemotherapy is a common approach to treating many forms of cancer. The drugs used in chemotherapy kill malignant cells or prevent them from dividing and making copies of themselves so that a tumor can grow and spread. Chemotherapy is sometimes administered after surgery to decrease the likelihood that the cancer will return, which is known as adjuvant therapy. Only one chemotherapy drug, dacarbazine (which is injected in a doctor’s office), is approved for treating melanoma. An oral version of the drug, temozolomide, is sometimes used in stage IV melanoma. Other chemotherapy drugs may also be administered for melanoma patients. However, chemotherapy is no longer offered to melanoma patients as often as in the past, since new medications that are more effective and less toxic have become available.

Radiation Therapy

While most melanoma patients do not require radiation therapy, it can play a role in some cases. Radiation therapy uses high-energy invisible beams to kill cancer cells. The most common form used in cancer therapy is called external beam radiation therapy, which is delivered from outside the body. In some cases, other forms of radiation therapy are used.

Some reasons your doctor may recommend radiation therapy as part of melanoma treatment include:

• To treat early-stage melanoma when surgery isn’t an option.
• To destroy any remaining cancer cells after surgery.
• To aid treatment of melanoma that has returned, or recurred.
• To help relieve symptoms caused by metastatic melanoma.

Immunotherapy

Your body has a natural defense network called the immune system. The purpose of immunotherapy is to strengthen the immune system and make it better able to fight cancer, including melanoma that can’t be cured by surgery. There are several forms of immunotherapy available for advanced melanoma.

• Immune checkpoint inhibitors: Cancer cells have strategies that help them elude detection by the immune system, which include turning protective immune cells to the “off” position, allowing malignancies to grow and spread. Immune checkpoint inhibitors block proteins on immune cells that cancer cells use to pull off this trick. That turns immune cells back to the “on” position so that they can lead an attack on a tumor. Immune checkpoint inhibitors are typically prescribed when melanoma can’t be treated by surgery and/or it has spread from the skin to other parts of the body. Some immune checkpoint inhibitors used to treat melanoma include:
  • Pembrolizumab (Keytruda)
  • Nivolumab (Opdivo)
  • Atezolizumab (Tecentriq)
  • Ipilimumab (Yervoy)
  • Relatlimab (which is combined with nivolumab in the drug Opdualag)

• Interleukin-2 (IL-2): Your body makes proteins called interleukins that rev up the immune system. Human-made versions of these proteins produced in a lab called interleukin-2 (IL-2) were once more widely used, but immunotherapies are preferred today. However, IL-2 may be an option for some patients.
• Oncolytic virus therapy: Viruses can infect healthy cells and cause illness. In oncolytic virus therapy, these pathogens are trained to attack and kill cancer cells. One form, called talimogene laherparepvec (Imlygic) may be used to when melanoma can’t be treated with surgery.

Less frequently used forms of immunotherapy in treatment of melanoma include Bacille Calmette-Guerin (BCG) vaccine, which is a germ that does not cause disease but can trigger the immune system to attack cancers; and imiquimod (Zyclara), a cream that is applied to the skin in order to stimulate an immune response. Doctors sometimes choose imiquimod for very early melanomas as an alternative to surgery to avoid scarring, such as on the face.

Targeted Therapy

Scientists have identified several gene mutations, or alterations, that appear to play a role in causing melanoma cells to grow uncontrollably, form tumors, and spread. A targeted therapy is designed to identify and attack cancer cells that have these genetic mutations. Because these cutting-edge treatments are designed to strike only a specific target, they may be less likely than chemotherapy to harm healthy tissue and cause side effects.

Targeted therapies for melanoma fall into several groups:

• BRAF inhibitors: About half of melanoma patients have mutations in the BRAF gene, which produces an abnormal version of a protein called BRAF that promotes growth of cancer cells. BRAF inhibitors block this abnormal protein. BRAF inhibitors include:
  • Vemurafenib (Zelboraf)
  • Dabrafenib (Tafinlar)
  • Encorafenib (Braftovi)
• MEK inhibitors: MEK gene mutations produce an altered version of a protein that works with BRAF proteins to promote melanoma. MEK inhibitors are often combined with BRAF inhibitors. MEK inhibitors include:
  • Trametinib (Mekinist)
  • Cobimetinib (Cotellic)
  • Binimetinib (Mektovi).
• C-KIT inhibitors: Melanoma patients who have mutations in the C-KIT gene may be candidates for the following targeted therapies:
  • Imatinib (Gleevec)
  • Nilotinib (Tasigna)

Clinical Trials

If you have melanoma that can’t be treated by surgery, it’s important to consider all of your treatment options. That includes participating in a clinical trial, in which researchers evaluate the benefits and safety of new, potentially life-saving therapies. Massive Bio’s artificial intelligence-powered platform, SYNERGY-AI, scans thousands of clinical studies in seconds to identify clinical trials that are recruiting patients like you. If you’re interested in enrolling in a clinical trial, contact Massive Bio today.

Living With and Managing Melanoma

Learning that you have any form of cancer can be a stressful and frightening experience. If you have recently been diagnosed with melanoma, you may find yourself struggling to learn new medical terms and make sense of the different treatment options.

If you have already begun treatment for melanoma or any other form of cancer, you’re facing new physical and emotional challenges, too. Some treatments for melanoma can cause side effects that may interfere with your daily routine and leave you feeling depleted. And if you’re not getting the results from therapy that you and your doctor hoped for, you may be feeling anxious and worried.

Even completing treatment for melanoma or other forms of cancer doesn’t always bring relief. After all, you may have concerns about the cancer returning, which is known as recurrence. Rest assured that you are not alone, as many cancer patients share these and other complex feelings. Knowing what to expect during your journey and adopting certain strategies can help you enjoy better quality of life while you manage melanoma.

What To Expect During and After Treatment

Undergoing treatment for cancer means adapting to a “new normal,” since many aspects of your life will change. Your daily routine, what you eat, how you feel—these and other things you take for granted will likely undergo a shakeup.

You will also find yourself getting to know and working closely with a new group of people, in the form of your medical team, whom you will see regularly. It’s critical that you attend all scheduled appointments and get any ordered lab work or imaging tests completed on time. It’s also essential to tell your team about any side effects that you experience from medications or concerns you may have about your treatment plan.

This new relationship with your care team can become deep and meaningful. Many patients report feeling a sense of loss and absence when treatment is over and they no longer see their doctors, nurses, and other healthcare professionals who treat their cancer as frequently, though you will most likely return to the clinic for routine follow-up appointments. Here again, it’s vitally important that you don’t skip those sessions, which are essential for monitoring your post-treatment wellbeing.

Coping With Treatment Side Effects

Effective treatments for melanoma are available, but the unfortunate reality is that many cause side effects. Most are temporary and will disappear after treatment ends. Ask your healthcare team what side effects that you might experience from your treatment plan and how you can minimize them. Depending on which treatment for melanoma you receive, they might include:

• Scarring
• Flu-like symptoms
• Fatigue
• Cough
• Gastrointestinal problems, such as constipation, diarrhea, and nausea
• Poor appetite
• Joint pain
• Skin irritation

Patients who undergo surgery for melanoma are often concerned about the possibility of having a permanent scar on their skin. That’s especially true when a patient has a melanoma tumor removed from the face. Doctors emphasize that scars look their worst immediately following surgery and can take months to heal fully. Limiting activity (to avoid stretching the skin) and keeping the wound moist and protected from sunlight will help a scar heal. However, there are treatment options that can help soften a post-surgical scar’s appearance. Your doctor can tell you about steroid treatments and laser therapies for scars.

Some melanoma patients require treatment to remove lymph nodes, or doctors elect to treat lymph nodes with radiation therapy. Depending on which lymph nodes are treated, this can cause fluid buildup under the arm or in the groin, a condition called lymphedema. Check with your healthcare team about how to manage this condition. Options include special support garments and massages (known as a lymphatic drain massage).

Protecting Your Skin

Taking steps to protect skin makes sense for everyone, but having any form of skin cancer once increases your risk for a second bout with the disease, so if you have had melanoma be sure you follow these rules:

• Stay out of the sun when possible: Plan outdoor activities before 10 a.m. and after 4 p.m. to avoid the sun’s damaging ultraviolet (UV) rays.
• Don’t use tanning beds or sun lamps: They tan skin with harmful UV rays.
• Cover up: When you do venture outdoors, wear garments that cover the arms and legs. Favor dark-colored clothes made of tightly woven fabrics. Hats, preferably wide-brimmed, are essential, too.
• Wear sunscreen: Choose products with a sun-protection factor (SPF) of 30 or higher that state “broad spectrum” on the label, meaning they block all damaging UV rays. Apply sunscreen liberally and reapply every few hours you’re outdoors, after swimming, and if you perspire heavily.

Coping With Emotional Stress 

Living with any form of serious illness can leave you feeling stressed-out, anxious, and depressed. It’s important to recognize that your world may be different due to cancer-related changes in your body, identity, personal and professional roles, and even your perspective on life. Be open about your feelings with family and friends, and encourage others to speak their minds, too. Be honest and specific about what they can do for you. Talking about your feelings with a mental health professional may help, too. So can including any of the following activities in your daily routine.

• Get some exercise, such as taking a brisk walk.
• Try meditation, yoga, or other techniques that relax the mind and body.
• If it’s part of your tradition, pray or engage in other spiritual activities.
• Become engrossed in favorite hobbies or explore new ones.
• Spend time with friends and family.
• Join a support group for cancer patients.
• Do some light gardening or simply spend time in nature.
• Read an absorbing novel.
• Listen to soothing music.
• Watch a movie that makes you laugh and lifts your spirits.

Coping With the Cost of Cancer Care 

Cancer treatment can be expensive, which may add to the stress and anxiety patients and their families are already experiencing. In addition to treatment costs, you may have other unplanned expenses related to your care, such as traveling long distances for treatment. For some people, the high cost of medical care leads them to stop taking or receiving necessary treatments, which can worsen outcomes. Be sure to discuss financial issues and concerns you may have with a member of your healthcare team. They may be able to refer you to philanthropic organizations that help people manage the cost of cancer care.

Caring for a Loved One with Cancer 

Assuming the role of caregiver for a person with cancer or any other serious illness means taking on a wide range of responsibilities. It can impose emotional, physical, social, and even financial burdens on you, which can at times strain your relationship with the person in need of care. If you care for someone with cancer, these strategies can help ease the burden for both of you.

• Listen:Let your loved one speak his or her mind, and listen without interrupting, passing judgment, or dismissing or downplaying his or her concerns. Letting a cancer patient share those feelings is critically important.
• Educate yourself: Learning about your loved one’s disease can help you better understand and appreciate what he or she is experiencing while living with cancer. It will also help you serve as an advocate and second set of ears for your loved one when his or her doctor explains complex medical concepts and makes treatment recommendations. At home, you’ll also be better equipped to monitor your loved one’s health and how well he or she is complying with prescribed treatments. The American Cancer Society, CancerCare, and other reputable organizations have helpful literature and user-friendly websites that provide detailed information about cancer treatments, side effects, and other related concerns.
• Give advice, but only when asked:Doing research on your loved one’s diagnosis and treatment options (including clinical trials) can be an enormous help, since all that information can seem overwhelming. But don’t tell him or her what choice to make. Instead, let your loved one know you’ve done research, then let him or her decide if they want to know more.
• Support your loved one’s treatment decisions:While your loved one may seek your opinion and ask you to share in decision-making, ultimately he or she must bear the impact of that choice. It’s important to be supportive of whatever decision he or she makes.
• Be organized: As a caregiver, you may have to schedule appointments, make travel plans, keep track of bills and medical records, and manage a budget. Setting up a system for record-keeping and setting calendar reminders for office appointments, procedures, and scheduled medications is essential.
• Ask for help: If your parent, spouse, or someone else close to you has cancer, you may be in the position of providing around-the-clock care. Failing to take time for yourself is a prescription for burnout, which can harm your relationship with the person you’re caring for. Ask other family members and friends to give you a break now and then.
• Stay connected: Cancer treatment can take months, even years, and the journey continues past the last day of treatment. People with cancer often note that friends and family fall out of touch after the initial crisis of diagnosis. Frequent visits, calls, texts, and emails can boost a loved one’s spirit.
• Keep things normal: You might be tempted to do as much as possible for a loved one with cancer as a way of feeling useful at a time when we might otherwise feel helpless. However, it’s important to respect your loved one’s wishes to engage in everyday tasks. For some people, being able to continue with a daily routine, even something as simple as making dinner, can lessen the sense that cancer is taking over their lives.

Sources: American Cancer Society, American Society of Clinical Oncologists, Skin Cancer Foundation

Melanoma Risk Factors and Prevention

A risk factor is anything about you that increases your risk for a specific disease. Scientists have identified many risk factors for melanoma. Having a risk factor for a disease doesn’t guarantee you will get sick, but it should serve as a caution to speak with your doctor about what preventive measures you can take. While some melanoma risk factors can’t be modified, you can take important steps that will lower your odds of developing this serious form of skin cancer.

What Are Risk Factors for Melanoma?

Anyone can develop melanoma, but these factors increase the risk:

• Sun exposure: Sunlight is the most abundant source of ultraviolet (UV) rays, which damage the DNA of skin cells and cause them to grow uncontrollably. There are different types of UV rays. Scientists used to think that only ultraviolet B (UVB) harmed skin and increased cancer risk, but now it’s clear that ultraviolet A (UVA) rays play a role, too.
• Use of tanning beds or sun lamps: These artificial sources of UV rays are harmful to the skin. Using a tanning bed increases the risk for all forms of skin cancer, including melanoma. The Skin Cancer Foundation estimates that a single session in a tanning bed before age 35 increases the risk for melanoma by an astonishing 75 percent. There is no safe way to use a tanning bed or sun lamp.
• A history of sunburns: Frequent sunburns, especially bad burns that cause blistering during childhood, predispose people to melanoma.
• Skin tone: White people are about 20 times more likely than Black people to develop melanoma. A white person with fair skin tone is even more at risk. People who have blonde or red hair, and blue or green eyes, are also more likely to have melanoma. However, people with any skin tone can be diagnosed with this form of skin cancer.
• Where you live: People who live in parts of the world that remain sunny all or most of the year have an increased risk for skin cancer, including melanoma. Some of the highest rates of melanoma in the world are found in Australia and New Zealand.
• Age and sex: The likelihood of developing skin cancer increases as you grow older. This is particularly true among males, who have a greater overall risk for melanoma.
• Moles: Practically all adults have at least a few moles, which are clusters of cells called melanocytes that contain pigment and are usually dark and raised. (Your doctor may use the term nevus instead of mole.) Most moles are benign, or harmless, but a melanoma can resemble one of these skin spots, though they tend to have unusual features, such as being asymmetrical or having jagged edges. Having 50 or more moles also increases the risk for developing melanoma, according to the American Academy of Dermatology. (In rare cases, a common mole can turn cancerous.)
• Family history: If you have a close relative (such as a parent or sibling) who had melanoma, your risk for developing this form of skin cancer is two or three times higher than average. Mutations, or alterations, in certain genes appear to increase the risk for melanoma.
• Your medical history: If you have already had skin cancer, your risk for melanoma is increased. That includes a prior case of melanoma, as well as basal cell carcinoma or squamous cell carcinoma, which are more common, but less serious. If your immune system is compromised for any reason, such as if you had an organ transplant and take anti-rejection drugs, you’re at higher risk for melanoma. Having an inherited condition called xeroderma pigmentosum makes you more vulnerable to skin cancer. Melanoma is more common in people with certain other inherited conditions, such as Li-Fraumeni syndrome and Werner syndrome.
• Environmental exposures: You may be more vulnerable to melanoma if you have a history of exposure to radiation, solvents, vinyl chloride, or PCBs.

How Can I Prevent Melanoma?

Some simple, commonsense steps can lower your risk for melanoma and other forms of skin cancer, including:

• Limit your sun exposure: Avoiding the sun at midday, when its UV rays are strongest, protects the skin from damage that can increase the risk for melanoma. The American Cancer Society recommends keeping out of the sun from 10 a.m. to 4 p.m., if possible. Remember, sunlight reflects off surfaces such as sand and water, so even sitting under an umbrella at the beach can leave you exposed.
• Cover up: When you do venture outdoors, wear long-sleeved shirts and garments that cover the legs, such as long pants or skirts, when possible. The best choices are dark-colored clothes made of tightly woven fabrics. You can also purchase specially made garments with coatings that absorb UV rays. Hats are essential, too, preferably with broad brims that provide shade for the neck and ears. Again, head coverings made with tightly woven fabrics are preferable to looser weaves, such as straw hats.
• Wear sunscreen: Following several rules will help you get the most protection from sunscreen:
  • Read the label before you buy: Look for the phrase “broad spectrum,” which means it blocks both UVA and UVB rays. Purchase products with a sun-protection factor (SPF) number of at least 30, preferably higher.
  • Don’t skimp: Dermatologists recommend using at least an ounce (the amount that would fill a shot glass) of sunscreen to cover all your exposed body parts.
  • Reapply often: You should reapply sunscreen if you remain in the sun for more than two hours, if you go swimming, or if you perspire heavily, especially if you towel off your skin.
• Don’t use tanning beds or sun lamps: They expose the skin to damaging UV rays. If you want to deepen your skin tone, use artificial tanning products.

Sources: American Academy of Dermatology, American Cancer Society, American Society of Clinical Oncology

Melanoma Clinical Trials

Clinical trials are studies that are designed to allow researchers to evaluate the benefits and safety of new treatments in volunteer patients. All prescription drugs that are approved today were tested in clinical trials before they could be sold. Clinical trials of new medications generally include three phases. In phase 1, a promising new medicine is tested in a small group of human subjects. The primary focus of a phase 1 trial is identifying a safe dose of a drug, but researchers also look for evidence that it is effective. A phase 2 trial involves a larger group of patients. If results of this phase suggest that the drug candidate appears to be effective with minimal side effects, it can then be tested in a phase 3 study in a larger number of patients. If a phase 3 study shows that a new medicine’s benefits outweigh its risks, the drug can be submitted to regulators (such as the Food and Drug Administration in the United States or the European Medicines Agency in the European Union) for approval.

People who volunteered to enroll in clinical trials were among the first patients to receive groundbreaking new therapies that have revolutionized the treatment of advanced melanoma by prolonging survival compared to the standard of care, often while causing fewer side effects. Those leading-edge medicines include:

Immunotherapies: This class of drugs trains the immune system to detect and destroy cancer tumors. Innovative new drugs called immune checkpoint inhibitors foil cancer cells’ efforts to “hide” from the immune system, allowing T cells to detect and lead an attack on tumors.

Targeted therapies: Scientists have identified several gene mutations, or alterations, that appear to play a role in promoting the growth and spread of melanoma tumors. Targeted therapies are designed to find and destroy cancer cells that have these genetic mutations.

However, while new immunotherapies and targeted therapies have benefited legions of patients, not everyone responds to these drugs and most who do ultimately develop resistance to them over time, so research on new treatments for advanced melanoma continues. Scientists are developing and studying novel forms of immunotherapy and targeted therapy for this skin cancer, as well as testing different combinations of existing and experimental drugs. New offerings for advanced melanoma currently being investigated in clinical trials include:

• Tumor-infiltrating lymphocytes: In this form of T-cell therapy, a doctor removes a sample of tissue from a tumor, which is sent to a lab. Proteins called tumor-infiltrating lymphocytes (TILs) are harvested from the tumor and grown to increase their numbers to millions. The patient undergoes chemotherapy, then TILs are infused back into his or her bloodstream. A recent phase 3 clinical trial found this treatment to be effective in advanced, inoperable melanoma.
• Immunocytokines: Clinical trials are underway on a new class of therapies called immunocytokines, which consist of a monoclonal antibody (a lab-made version of naturally occurring immune-defender cells) and proteins called cytokines that help lead attacks on foreign bodies. Immunocytokines can find tumors, then trigger a response by the immune system to attack it.
• Vaccines: While the vaccine you get for the flu or COVID-19 reduces the risk for disease, some vaccines are designed to fight disease. Anti-tumor vaccines are under study for various forms of cancer, including melanoma. These vaccines contain killed melanoma cells; when injected into the body, the goal is to stimulate an immune response to seek and destroy melanoma tumors.

How Can I Find a Clinical Trial?

According to the U.S. National Library of Medicine, more than 500 clinical trials of new treatments for melanoma are underway around the world. If you have melanoma and you’re interested in participating in a clinical trial, Massive Bio can help you find the study that’s right for you with our SYNERGY-AI, our artificial intelligence (AI)-powered platform. SYNERGY-AI searches multiple clinical trials to produce personalized matches based on more than 170 clinical algorithms to find the best treatment option for you.

How Can I Enroll in a Clinical Trial?

Using the personalized matches produced by our platform, you and your doctor can determine which clinical trial is right for you, based on the type and stage of your cancer, your personal preferences and priorities, and other factors. Before you agree to participate in a clinical trial, contact your insurance company to find out if the cost of treatment will be covered or whether the pharmaceutical company sponsoring the trial will help cover your expenses.

Melanoma Clinical Trials 

Clinical trials are studies that are designed to allow researchers to evaluate the benefits and safety of new treatments in volunteer patients. All prescription drugs that are approved today were tested in clinical trials before they could be sold. Clinical trials of new medications generally include three phases. In phase 1, a promising new medicine is tested in a small group of human subjects. The primary focus of a phase 1 trial is identifying a safe dose of a drug, but researchers also look for evidence that it is effective. A phase 2 trial involves a larger group of patients. If results of this phase suggest that the drug candidate appears to be effective with minimal side effects, it can then be tested in a phase 3 study in a larger number of patients. If a phase 3 study shows that a new medicine’s benefits outweigh its risks, the drug can be submitted to regulators (such as the Food and Drug Administration in the United States or the European Medicines Agency in the European Union) for approval.

People who volunteered to enroll in clinical trials were among the first patients to receive groundbreaking new therapies that have revolutionized the treatment of advanced melanoma by prolonging survival compared to the standard of care, often while causing fewer side effects. Those leading-edge medicines include:

Immunotherapies: This class of drugs trains the immune system to detect and destroy cancer tumors. Innovative new drugs called immune checkpoint inhibitors foil cancer cells’ efforts to “hide” from the immune system, allowing T cells to detect and lead an attack on tumors.

Targeted therapies: Scientists have identified several gene mutations, or alterations, that appear to play a role in promoting the growth and spread of melanoma tumors. Targeted therapies are designed to find and destroy cancer cells that have these genetic mutations.

However, while new immunotherapies and targeted therapies have benefited legions of patients, not everyone responds to these drugs and most who do ultimately develop resistance to them over time, so research on new treatments for advanced melanoma continues. Scientists are developing and studying novel forms of immunotherapy and targeted therapy for this skin cancer, as well as testing different combinations of existing and experimental drugs. New offerings for advanced melanoma currently being investigated in clinical trials include:

• Tumor-infiltrating lymphocytes: In this form of T-cell therapy, a doctor removes a sample of tissue from a tumor, which is sent to a lab. Proteins called tumor-infiltrating lymphocytes (TILs) are harvested from the tumor and grown to increase their numbers to millions. The patient undergoes chemotherapy, then TILs are infused back into his or her bloodstream. A recent phase 3 clinical trial found this treatment to be effective in advanced, inoperable melanoma.
• Immunocytokines: Clinical trials are underway on a new class of therapies called immunocytokines, which consist of a monoclonal antibody (a lab-made version of naturally occurring immune-defender cells) and proteins called cytokines that help lead attacks on foreign bodies. Immunocytokines can find tumors, then trigger a response by the immune system to attack it.
• Vaccines: While the vaccine you get for the flu or COVID-19 reduces the risk for disease, some vaccines are designed to fight disease. Anti-tumor vaccines are under study for various forms of cancer, including melanoma. These vaccines contain killed melanoma cells; when injected into the body, the goal is to stimulate an immune response to seek and destroy melanoma tumors.

How Can I Find a Clinical Trial?

According to the U.S. National Library of Medicine, more than 500 clinical trials of new treatments for melanoma are underway around the world. If you have melanoma and you’re interested in participating in a clinical trial, Massive Bio can help you find the study that’s right for you with our SYNERGY-AI, our artificial intelligence (AI)-powered platform. SYNERGY-AI searches multiple clinical trials to produce personalized matches based on more than 170 clinical algorithms to find the best treatment option for you.

How Can I Enroll in a Clinical Trial?

Using the personalized matches produced by our platform, you and your doctor can determine which clinical trial is right for you, based on the type and stage of your cancer, your personal preferences and priorities, and other factors. Before you agree to participate in a clinical trial, contact your insurance company to find out if the cost of treatment will be covered or whether the pharmaceutical company sponsoring the trial will help cover your expenses.