Treating Melanoma

Melanoma, a rare skin cancer, is dangerous because it is likely to spread if it is not found early and treated. However, there is hope. Amy Harker-Murray, MD, medical oncologist and Medical College of Wisconsin faculty member, discusses promising new treatments. 

What is melanoma? 

Melanoma arises from pigmented skin cells called melanocytes. A pre-existing mole can turn into melanoma, or it can develop within the cells of otherwise normal-looking skin. It tends to be aggressive and can spread quickly to nearby lymph nodes or organs. 

Who is most at risk for melanoma? 

People who have light-colored skin, hair and eyes are more likely to develop melanoma, but people with darker skin tones can also develop this disease. People who have sporadic but intense exposure to the sun are at higher risk than people who have chronic sun exposure. Other risk factors include the tendency to burn easily, suffering a blistering sunburn or having a higher-than-average number of moles. Finally, immunosuppressed people, such as those taking drugs to prevent organ rejection after transplant, must be especially vigilant about their skin because they are at higher risk for melanoma. 

Can people survive a melanoma diagnosis? 

Yes, enthusiastically, yes. The earlier we find melanoma, the better the chance of survival. Melanoma-in-situ is confined to the top layer of the skin. We remove it, essentially, curing it because it has not invaded the body. Even melanoma that has penetrated 1-2 millimeters into the skin has less than a 5% chance of a life-threatening recurrence within five years. More than 80% of patients with melanoma that has only spread to a small number of lymph nodes will be alive in five years. 

How has melanoma treatment changed? 

Treatment mainstays have been surgery, usually effective in curing early-stage disease, radiation therapy to prevent recurrence after surgery, and sometimes, chemotherapy. Ten years ago, we did not have effective medications, but that is no longer true. 

What effective treatments are available today? 

We have targeted therapy combinations known as BRAF/MEK inhibitors — drugs that target a mutation in the cells of some metastatic melanomas. These therapies can prevent cancer from returning even when it has spread to other parts of the body. Another option is immune checkpoint inhibitors that prompt the immune system to recognize and destroy melanoma. We also use a genetically modified virus that we inject directly into lymph nodes or metastatic tissue. 

What is one of the newest treatments you can offer patients? 

We participated in clinical trials for lifileucel, recently approved by the FDA for people with stage IV melanoma. Lifileucel, a type of immunotherapy, uses tumor-infiltrating lymphocytes, white blood cells from the patient’s own tumor, to target melanoma. The cells are strengthened and multiplied in a lab. We inject them into the patient’s bloodstream, where they find and eliminate cancer cells. So far, people are living several months to a year longer than they do without lifileucel. We are hopeful for longer-term disease control. 

What excites you about your specialty? 

According to the National Cancer Institute, melanoma’s mortality rate has fallen by almost 30% in the last decade, largely because we are finding effective treatments — even for people who have advanced disease. The best part of my day is telling a patient they do not need to see me anymore. I love celebrating that milestone with them.