Bringing together the most advanced medical, surgical and research resources available to fight the most virulent form of skin cancer, University of Washington Medical Center has established a multidisciplinary Melanoma Center.
The center provides state-of-the-science treatment for patients with malignant melanoma, including gene therapy, lymphatic mapping to determine the spread of the disease into the lymph system, and the opportunity to participate in clinical trials of new drugs and vaccines.
The physician team includes surgical oncologists Dr. David Byrd and Dr. Raymond Yeung; medical oncologists Dr. John Thompson and Dr. Philip Gold; and dermatologic pathologist Dr. Michael Piepkorn.
The Melanoma Center sees patients referred by dermatologists and primary care doctors in the five-state region to which UW Medical Center provides highly specialized care: Washington, Wyoming, Alaska, Montana and Idaho. According to clinic coordinator Stacy Neumann, some 90 percent of patients are referred by physicians. The center sees about 300 new patients a year, as well as about 1,560 patients making return visits.
To pinpoint the spread of melanoma, UW Medical Center since 1992 has used lymphatic mapping, a technique recently begun for breast cancer as well. Lymphatic mapping involves injecting two imaging substances — a radioactive tracer and a blue dye — next to the primary tumor site, before the tumor is removed surgically. A body scan follows the tracer’s path as it drains to the lymph basin, and an incision is made over the “hot spot” identified by the tracer. The blue dye shows the surgeon the first node in the drainage path, the “sentinel” node, which is removed and biopsied. If it is cancer-free, experience shows that in more than 95 percent of cases, the cancer has not spread to other lymph nodes.
“With lymphatic mapping, the spread of cancer can be tracked with much greater accuracy to the sentinel node, reducing or eliminating the need to remove many nodes,” said Byrd. Among other treatments offered, the Melanoma Center uses the drugs interferon and interleukin-2 to mobilize the body’s immune system to fight advanced melanoma.
In addition, researchers are investigating several vaccines to stop the development and progression of the disease, as well as an extremely sensitive diagnostic test, polymerase chain reaction or PCR, that can detect one cancer cell in a million.
“Melanoma survival has improved with early diagnosis,” said Byrd. “Eighty percent can now be cured with a wide excision. Melanoma has been notoriously resistant to chemotherapy and radiation, but there has been progress in both areas.”
“The good news is that melanoma can be treated effectively if caught early,” said Thompson. “An ounce of prevention truly is worth a pound of cure when it comes to combating this disease.”
Facts about Melanoma from the American Cancer Society and National Cancer Institute
- Incidence: 40,000 persons will be diagnosed with melanoma this year in the United States. Deaths from melanoma will number about 7,300. Incidence of melanoma has increased about 4 percent a year, from 5.7 per 100,000 in 1973 to 12.2 per 100,000 in 1993. Incidence of melanoma is much higher among light-skinned people.
- Signs and symptoms: A change in the size or color of a mole or other darkly pigmented growth or spot; scaliness, oozing, bleeding or change in appearance of a bump or nodule; spread of pigmentation beyond its normal border; change in sensation, itchiness, tenderness or pain.
- Risk factors: Excessive exposure to ultraviolet radiation; fair complexion; occupational exposure to coal tar, pitch, creosote, arsenic compounds or radium; family history; multiple moles; or atypical moles.
- Prevention: Wear protective clothing and sunscreen; avoid sun exposure, especially between 10 a.m. and 3 p.m. Because of a possible link between severe childhood sunburns and greatly increased risk of melanoma later in life, children in particular should be protected from the sun.
- Early detection is critical. Examine your skin once a month; suspicious lesions should be evaluated promptly by a physician. Melanomas often start as small, mole-like growths that increase in size and change color. Any sudden or progressive increase in size is of particular concern. Melanomas can occur in areas that are not sun-exposed.
- ABCD list of warning signals: A is for assymetry; one-half of the mole does not match the other half. B is for border irregularity; edges are ragged, notched or blurred. C is for color; pigmentation is not uniform or intensely black. D is for diameter greater than 6 millimeters (the diameter of a pencil eraser).
- Treatment: After biopsy, surgical excision is the initial treatment for all stages of melanoma. Depending on the stage, some lymph nodes may be removed in addition to the primary tumor site and surrounding area. Surgery may be followed by chemotherapy, radiation therapy or biological therapy (using the body’s immune system to fight the cancer, with interferon or interleukin-2).
- Survival: Malignant melanoma can spread quickly. When detected in its earliest stages and with proper treatment, it is highly curable. When melanoma is diagnosed at advanced stages, the prognosis is more guarded.