What You Need To Know NOW About Melanoma
Clinical Professor of Dermatology
Director, Melanoma Surveillance Clinic
Mount Sinai Icahn School of Medicine, New York, NY
Adjunct Professor, UT Southwestern Medical School
Consultant Dermatologist, Cooper Clinic, Dallas, TX
Advancements in the detection and treatment of melanoma are occurring at a rapid pace. To help the audience keep track of everything, Darrell S. Rigel, MD, MS, provided updates on cutaneous melanoma in this session. Beginning with epidemiology, Dr Rigel informed the audience that the prevalence and risk of melanoma continue to increase, with the current lifetime risk of having melanoma estimated to be 1 in 26. Men are more likely to be diagnosed with invasive melanomas, while patients with skin of color have worse 5-year survival rates than White patients.
Moving on to risk factors for developing melanoma, Dr Rigel discussed the importance of sun protection and the known correlation between sunburns and melanoma risk. Melanoma incidence is increased in transplant patients, and a recent study found melanoma recurrence rates to be higher when the primary melanoma is diagnosed during pregnancy, indicating a need for increased surveillance for these patients. Studies have shown a potential link between sildenafil use and melanoma risk, but Dr Rigel told the audience that more studies need to be done to verify this risk.
Dr Rigel reviewed tools to assist in the diagnosis of melanoma, including dermoscopy, electrical impedance spectroscopy, and tests to assess for lesional genomic atypia. Use of tape stripping to assess genomic atypia leads to an almost 5-fold enrichment of histopathologic features associated with melanoma compared to those biopsied based on visual assessment alone. Dr Rigel also reviewed commonly used prognostic indicators for patients diagnosed with melanoma. Breslow thickness and mitotic rate continue to be highly predictive of recurrence. Dr Rigel provided the audience with an in-depth review of the 31-gene expression profile (GEP) test for melanoma prognosis. Validation studies have shown that the use of GEP results can improve prognostic assessment for those with tumors at least 0.3 mm in depth and can also identify a high-risk subset for recurrence and distant metastasis in patients traditionally thought to be low-risk, such as those with T1a tumors or those with a negative sentinel lymph node biopsy.
To conclude, Dr Rigel briefly updated the audience on the latest in the surgical and medical treatment of melanoma. Recent studies have shown that delay in surgical treatment beyond one month is associated with worse overall mortality. Local recurrence rates were found to be lower with Mohs micrographic surgery or staged excision compared with wide local excision. Dr Rigel discussed a recent study showing rates of metastatic melanoma progression while on checkpoint inhibitor therapy were higher in those without tumor-infiltrating lymphocytes (TIL) compared to those with TILs. Tumor-infiltrating lymphocyte therapy is being investigated for advanced melanoma, with a recent study showing improved overall survival with TIL therapy compared to ipilimumab. Other medical advancements in melanoma treatment include novel combinations of checkpoint inhibitors and an mRNA melanoma vaccine.