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MELANOMA



Typically, melanoma occurs on the skin, although in rare cases it can originate in other organs such as the eyes or mucous membranes. Melanoma is the most aggressive type of skin cancer, although it is not the most common. If not diagnosed early, melanoma is likely to invade nearby tissues and spread to other parts of the body.

The number of melanoma cases is increasing every year. Early diagnosis is performed by dermatologists, who are experts in pigmented lesions.

For medical oncologists, the greatest challenge is to treat advanced stage melanoma or those which are at a high risk of going on to develop metastatic disease.
 
Our goal is to achieve the best personalized treatment for melanoma according to the genetic characteristics of each patient’s tumor.

SYMPTOMS of melanoma
The signs of melanoma are changes in the appearance of a mole or pigmented area of the skin. Melanoma or other conditions can cause the following signs and symptoms:

1. A mole that has any of the following features:
  • Changes in size, shape or color.
  • Has irregular edges or borders.
  • Is more than one color.
  • It is asymmetric.
  • Is itchy.
  • Oozes, bleeds, or is ulcerated.
2. A change in skin pigment (color).
3. Satellite moles (new moles that grow near an existing mole).

You should consult a dermatologist if any changes or lesions appear on the skin or if they or existing moles itch, bleed or grow rapidly.

DIAGNOSTIC TESTS to detect melanoma
If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help dermatologist to detect and diagnose melanoma:

• Skin examination.
• Biopsy.

It is important that the abnormal areas of skin are not shaved or cauterized (destroyed with a hot instrument, an electric current or a caustic substance) since cancer cells that remain can grow and spread.

TREATMENTS for melanoma
Different types of standard treatment are available for patients with melanoma: surgery, chemotherapy, radiotherapy, immunotherapy, targeted therapy.

New types of treatment are being investigated in clinical trials.
PERSONALIZED TREATMENT for melanoma
Multiple genetic alterations have been identified in melanoma. Therapy directed against mutations in the BRAF gene acts on the genetic or molecular changes that promote growth, division and spread of cancer cells. Currently, vemurafenib and dabrafenib (BRAFV600 inhibitors) in combination with other drugs that inhibit MEK have been approved for the treatment of advanced melanoma. These treatments are very active against melanomas with BRAF mutations, although this does not last indefinitely.

In recent years, a great benefit has been achieved with the use of immunotherapy such as Yervoy (ipilimumab), Opdivo® (nivolumab) and Keytruda® (pembrolizumab). These are monoclonal antibodies that are administered in intravenous fluids during an outpatient appointment, and can achieve long-lasting responses to treatment. These treatments have already achieved long-lasting (several years) remissions in very advanced melanomas. Immunothearpy is currently one of the most interesting areas in oncology, since it offers the possibility to extend these favorable results to other patients via combination therapy. This is being investigated in clinical trials.

To have a genetic diagnosis of treatable alterations in melanoma, in addition to traditional tissue biopsy, the possibility of determining these mutations through a simple blood test, or "liquid biopsy", is particularly interesting. We are currently conducting clinical trials in our center in collaboration with the Spanish Melanoma Group (GEM).