The PET-CT if of great diagnostic importance when a melanoma tumor is metabolically active
Melanoma is a tumor whose origin is in the melanocytes of the skin and it the most aggressive type of skin cancer. Its incidence is less than other skin tumors such as basal cell carcinoma or squamous cell carcinoma, but it has shown a steady growth in recent decades.
Melanoma may also occur in the eye or in the mucous membranes of the body. These locations are rarer and require different diagnostic techniques and treatment.
At iTAcC a multidisciplinary team of dermatologists, general surgeons, plastic surgeons, nuclear medicine physicians, radiologists, pathologists, geneticists, medical oncologists and radiation oncologists work together in order to obtain a diagnosis and provide treatment of melanoma in a personalized way.
Melanoma occurs more frequently in people with a family history of it, persons that have been frequently exposed to the sun and with intensity (i.e. having suffered sunburn), persons with habitual exposure to tanning beds and patients with weakened immune systems.
Persons should exercise caution regarding exposure to the sun by using protective factors and undergo screening for the early detection of skin spots by having them evaluated by a specialist
iTAcC recommends performing a Digital Body Mapping which involves making digitized photographs of large areas of skin (middle back, lower back, arms, legs, thighs, face) in order to detect changes in the number, size or shape skin lesions. The dermatologist can automatically compare lesions with program called Bodyscan. A second analysis of the lesion by Dermoscopy is done if a lesion is suspicious or has undergone some change in appearance in a previous image. It is the most reliable method to confirm a clinical diagnosis of a nevus (birthmark) before its removal for a pathological study. It is necessary to analyze each nevus on an individual basis, especially those with atypical clinical features. This is done with a magnification x 20 and a solid immersion lens, polarized light, or both. The objective is to find new dermatoscopic parameters which determine whether a lesion is benign, malignant, and suspicious or presents a risk and then acting accordingly. This method is reliable. Today it is considered to be a scientifically established method which avoids having to remove the nevus in excess or not removing a malignant lesion because its characteristics are negligible, as well as monitoring changes that occur in nevi over the years.
Melanoma usually appears as a dark spot, irregularly shaped, and with a sudden appearance. It may also include satellite spots.
The dermatologist performs a complete removal of the lesion (excisional biopsy) for histopathologic examination in the case of a suspected diagnosis.
When a diagnosis of melanoma has been confirmed a series of tests should be done to determine the true spread of the disease and to define the best treatment option in each case. The diagnostic protocol consists of imaging tests such as X-rays, ultrasound, CT scan (computed tomography) MRI (magnetic resonance imaging) or PET-CT, the latter being of great importance due to the fact that a melanoma is a metabolically active tumor.
Choosing the best treatment option first depends on the location of melanoma, degree, spread, clinical condition of the patients as well as their personal wishes.
ITAcC’s medical team believes that a higher success rate in treatment is achieved with the completion of an individualized treatment. Our treatments are governed by the parameters of personalized oncology maintaining direct contact with all the specialists involved in order to make the best treatment decision for each patient diagnosed with melanoma.
The treatment approach should be defined in a multidisciplinary committee which evaluates each case on an individual basis. At iTAcC there is a committee open to professionals and includes the opinions of dermatologists, general surgeons, plastic surgeons, nuclear medicine physicians, radiologists, anatomical pathologists, radiation oncologists and medical oncologists. Specialists trusted by the patient participate in the decision process when necessary. The purpose of this group of professionals is to provide treatment in a personalized manner in each case with ideal curative options along with the best functional results.
As in the case of any other tumor, treatment of melanoma depends on the stage of the disease:
Surgical removal is the recommended treatment when melanoma is found only in the skin. This must be done with safety margins so the entire lesion is removed guaranteeing disease free surgical margins. Sometimes it is necessary to perform the "sentinel node" technique. This is done with the collaboration of a nuclear physician for the administration of a radioactive isotope for detecting drainage of the tumor lymph nodes. A study is done during surgery and a decision is made whether or not to completely remove the lymph nodes along with the tumor.
Treatment of melanoma with metastasis of the lymph node metastasis, skin or other organs is done with a combination of chemotherapy, immunotherapy and radiation therapy.
Chemotherapy and immunotherapy
Chemotherapy is a systemic therapy that is administered intravenously. It includes several drugs which can be used individually or in combination depending on the phases of the disease, previous treatments and the general health of the patient. In many cases chemotherapy may be associated with immunotherapy. Immunotherapy is a treatment that stimulates the patient’s immune system.
Treatment with ipilimumab has shown very good results. It is being recommended in cases where the patient has already undergone chemotherapy and the disease has proven resistant (refractory) to the treatment.
Radiation therapy may be used by itself or in combination with chemotherapy and immunotherapy.
- Intense modulated radiotherapy and image guided radiotherapy techniques are used (IMRT/IGRT) at iTAcC as well as stereotactic body radiotherapy techniques (SBRT) or radiosurgery in selected cases as an alternative to surgery, especially in the case of brain involvement.
- Brain-sparing holo-cranial radiotherapy is the correct technique for the irradiation of brain tissue in cases of metastases. At iTAcC it is possible to irradiate using the IMRT and IGRT techniques while protecting the thalamus and basal ganglia at the same time which reduces the occurrence of side effects.
The Truebeam-STX brain makes it possible to carry out brain-sparing holo-cranial radiotherapy in combination with fractionated stereotactic radiotherapy techniques simultaneously.
iTAcC has the means to monitor and control the progress of patients who have had a melanoma in order to rule out the possibility of disease recurrence.
A follow up is done as in all oncological activity at our center in a personalized manner with the cooperation of physicians who have been involved in the diagnosis and treatment of each case.