Melanoma – An Introduction, with Dr. Paul Chapman

Last Updated: May 10, 2018

In this video, Dr. Paul Chapman gives an overview of the type of skin cancer called melanoma, including its different stages and new treatments.

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Guide to Melanoma

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Transcript: 

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Melanoma: An Introduction

Types of Skin Cancer

Paul Chapman, MD: There is at least three different types of skin cancers.  The most common ones are, are basal cell cancers and squamous cell cancers.  Melanoma is the, is less common than those, but melanoma is really by far the most deadly of the skin cancers. 

The other skin cancers are almost always easily cured with surgery.  Melanoma is the skin cancer that can metastasize, that is to say spread.

Stages of Melanoma

Dr. Chapman: What you need to know right away is what stage we’re talking about, because the outcomes are widely different depending on the stage.  Most melanomas are caught very early, in stage one or stage two.  That is melanoma that has not spread, that’s just sitting in the skin.  Those melanomas are generally removed surgically and have a very high chance of being cured.  

So stage one and stage two melanoma are also always treated with surgery.  Generally they don’t require any additional treatment, although there can be a little bit of differences.  Stage three is when it has spread to the lymph nodes.  That is generally treated with surgery.  And then there is some controversy in the field as to whether any additional treatment beyond surgery is necessary. 

That’s something that I think the patient should discuss with their doctor.  Stage four however, is when it is spread through the bloodstream and there surgery sometimes plays a role, but usually not.

New Treatments for People with Later Stage Melanoma

Dr. Chapman: So, what are the new treatments?  So the new treatments kind of come in two broad categories.  We have treatments now that activate the immune system to kill the melanoma and there are several drugs, either on the market or about to become on the market.  Epilimab [ph.] is an immunotherapy that was presented here in 2010 and has been FDA approved since 2011.  Epilimab has changed how we changed how we treat patients.

So, and at this year’s ASCO we received additional data on new drugs called anti PD1 antibodies and these data are extremely exciting and showing that these drugs also have remarkable effects on melanoma and we all expect one or two of these drugs to be FDA approved this year. 

So in the immunotherapy field there are new drugs beyond these groups that are coming down the pipeline that we expect to play a big role.  So, these immunotherapy drugs have already changed the outcome of metastatic melanoma.  On the other hand there is another group of drugs that are targeting gene mutations that we’ve learned about in melanoma.

Also, at the 2010 meeting we heard about data on a drug called [inaud.], which actually I presented here, also that drug was approved by the FDA the following year.  Since that time we’ve had several other targeted agents approved; [inaud.] and a [inaud.] inhibiter called [inaud.]. 

What we heard about at the meeting this year are new combinations of targeted drugs to block pathways in melanoma.  And so now we can start targeting melanomas that we couldn’t target before.  So, we have two broad categories of new drugs and we are pushing the survival curve as we say.  We are all seeing in our clinics, more and more patients, long-term surviving patients.

So, the whole, the whole outlook is changing

So, in patients who have stage four melanoma, metastatic melanoma, this is still a very serious situation and they are - patients are rightly concerned.  But, we do have hope now that we didn’t have before.  And in the 20th Century when I would see a patient with metastatic melanoma, I knew based on the drugs I had at the time that I was unlikely to make too much of a difference in that patient’s life

Now with the new drugs that we have available our attitudes and our expectations have changed.  I no longer expect patients to progress on melanoma, although sadly it still does happen.  But we have enough patients who have remarkable responds, long-term responses, that we now are expecting patients to do well with the drugs we have.  And this will only improve, I think, in the years to come.

Where to Get More Information

Dr. Chapman: Well, in the field of melanoma as we’ve been talking about, things are changing rapidly, even month to month sometimes.  And so it is important for patients not only to talk to their doctors but they’re egger to get information on the internet.  Cancer.net is one of the sites where, where we have melanoma experts annotating this on a regular basis, keeping up with it, and trying to write this in a way that would be helpful for patients.  So, I recommend my patients to check that website out first.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical OncologyConquerCancerFoundation.org  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center 

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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