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Melanoma Treatment

Melanoma treatment is challenging because it requires the involvement of several highly specialist physicians. Once diagnosed, the primary site of the melanoma must be excised by a board certified surgical oncologist. In order to ensure all of the cancer is removed, wide margins of seemingly uninvolved skin must be excised as well. As a result, complex reconstructive surgery is often necessary in order to restore the missing skin and soft tissue. The complexity of the reconstructive surgery varies based on the tumor’s location, size and proximity to vital anatomic structures, including the eye. Once the face or body has been restored by a board certified plastic surgeon, additional treatment may be required depending on the final pathology report and the risk that the cancer has spread to other parts of the body. At this point, a board certified medical oncologist must decide if cutting edge medications are indicated to prevent progression of the cancer in the future.

At the Melanoma NYC Center, our skilled surgeons and oncologists work as a team to provide comprehensive care in a uniquely personalized manner. This collaborative approach to melanoma treatment provides our patients with the best chance of long-term survival.

Melanoma Treatment Overview

The treatment of melanoma can be broken down into four stages.

 

1. Diagnosing Melanoma

When a suspicious lesion is detected, it must be biopsied in order to determine a diagnosis. During the biopsy, a dermatologist or plastic surgeon removes a small portion of tissue from the lesion and sends it to a lab for testing. If a diagnosis of melanoma is confirmed, the patient will be referred to a melanoma specialist, such as the Melanoma NYC Center. After the patient meets with our team of doctors, we will quickly create a plan to determine the stage of melanoma and to begin the appropriate treatment plan for the patient.

Size of melanoma Excision margin
Melanoma in situ 5mm
<1.0mm 1cm
1.0-2.0mm 1-2cm
2.0-4.0mm 1-2cm
>4.0mm 2cm

2. Wide Local Excision

In the majority of cases, the first step in treating melanoma is to perform a wide local excision to remove the tumor. Due to his vast experience, our surgical oncologist Dr. McCain, performs our wide local excisions at Lenox Hill Hospital. During this procedure, Dr. McCain removes the cancerous tumor and a margin of normal tissue surrounding the tumor. He decides how much normal tissue needs to be removed based on how deeply the melanoma has penetrated the skin. The table below shows the average surgical margins required based on the depth of the melanoma.

3. Reconstruction Surgery

After the melanoma has been completely removed, patients often require reconstructive surgery performed by our board certified plastic surgeon, Dr. Robert Morin. The reconstruction may occur immediately after the wide local excision or it may be delayed until the final pathology report has confirmed that all cancerous tissue has been removed. The complexity of reconstructive surgery varies based upon the tumor’s location, size, and proximity to vital anatomic structures. When a melanoma occurs on the face or other highly visible areas of the body, reconstructions are best performed by an experienced plastic surgeon. During the reconstruction at Lenox Hill Hospital, Dr. Morin utilizes a variety of techniques including, skin grafting, skin flaps, muscle flaps, or other complex repairs in order to restore the appearance and function of the area.

4. Additional Treatment, If Required

Dr. Pecora, our medical oncologist, will then determine if additional medications are required. If the tumor has spread to the lymph nodes or other areas of the body, additional treatment is always required. At the Melanoma NYC Center, we offer our patients a variety of medical treatment options, including the most cutting-edge advances in immunotherapy medicine. In addition to FDA-approved treatments, we can enter patients into NIH-sponsored clinical trials through our association with the John Theurer Cancer Center at Hackensack University Medical Center. Some of the advanced treatments that we offer our patients are Polynoma, a melanoma vaccine, Nivolumab, Keytruda, and checkpoint inhibitor immunotherapy. An updated list of currently enrolling melanoma cancer trials can be located here.

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