Clinician-to-Clinician Update Clinician-to-Clinician Update

New Surgical Approaches and Therapies for Melanoma Improve Outcomes

February 2017

More than 76,000 new cases of melanoma were diagnosed in the United States in 2016, and more than 10,000 Americans were expected to die of the disease before year’s end.1 As rates of melanoma—the sixth most common type of cancer—continue to rise2, surgical innovations and novel therapies show promise in helping patients manage and survive the disease.

One research focus has been improving the surgical management of affected lymph nodes in patients with melanoma. Surgical dissection of affected regional lymph nodes represents the standard-of-care approach and best potential for cure; however, morbidity rates for inguinal lymphadenectomy remain at approximately 50%.3 University of Minnesota Health surgeons, in partnership with surgeons at Mayo Clinic, were among the first in the United States to demonstrate the promise of minimally invasive inguinal lymph node dissection (MILND): a novel way to remove inguinal lymph nodes while reducing the postoperative complications associated with the traditional open approach to inguinal lymphadenectomy (open inguinal lymph node dissection, or OILND).

Feb-2017-Melanoma-Feature-Article-Main-UMMC CancerCare CSC DR Tuttle PT Tene 112916 219
— University of Minnesota Health surgeon Todd Tuttle, MD, is among the first in the U.S. to test minimally invasive inguinal lymph node dissection.

Conventional lymph node dissection sometimes leads to scarring, infection, and other postoperative complications. MILND, when compared to open procedures, provides an equivalent lymphadenectomy with lower rates of complication, a 2012 study authored by M Health surgeons and their Mayo counterparts reports.3 While MILND typically takes longer to perform than OILND, the procedure yields substantially lower rates of wound rupture and is associated with shorter hospital stays and lower hospital readmission rates.3

The significantly shorter incision length is thought to account for the lower wound complication rates.3 Since 2012, M Health surgeons have begun using the technique on a regular basis, and MILND has been adopted by several other institutions around the country, says Todd Tuttle, MD, one of the University of Minnesota Health surgical oncologists who helped develop the procedure.

New drug therapies are also emerging in the fight against melanoma. In fall of 2015, the FDA approved the use of T VEC (talimogene laherparepvec) as a therapy for melanoma that cannot be addressed through surgery, making it the first FDA-approved oncolytic virus therapy for cancer. A genetically modified herpes virus, T VEC is injected into melanoma tumors where it replicates and kills melanoma cells.4 Evidio Domingo-Musibay, MD, says most patients have tolerated it well.

Several melanoma clinical trials that will test immunotherapies are slated to open at University of Minnesota Medical Center in the coming months. University of Minnesota Health physicians are also leading research designed to review treatments and boost long-range outcomes of melanoma patients. M Health is a participating site within the national OPTIMIzE study, which aims to understand treatment patterns and improve quality of life for patients with unresectable and metastatic melanoma who are receiving cancer therapy. M Health oncologist Evidio Domingo-Musibay, MD, serves as the local site principal investigator in this 5-year study.


References

  1. National Cancer Institute. SEER stat fact sheets: melanoma of the skin. SEER Cancer Statistics Review. Washington, DC. The Institute, 2016.
  2. American Cancer Society. Survival rates for melanoma skin cancer, by stage. The Society. Rev. May 20, 2016. http://www.cancer.org/cancer/skincancermelanoma/detailedguide/melanoma-skin-cancer-survival-rates-by-stage. Accessed December 15, 2016. https://seer.cancer.gov/statfacts/html/melan.html. Accessed December 15, 2016.
  3. Abbott AM, Grotz TE, Rueth NM, Hernandez Irizarry RC, Tuttle TM, Jakub J.W. Minimally invasive inguinal lymph node dissection (MILND) for melanoma: experience from two academic centers. Ann Surg Oncol. 2013; 20:340–345. doi:10.1245/s10434-012-2545-6.
  4. U.S. Food & Drug Administration. FDA approves first-of-its-kind product for the treatment of melanoma. October 27, 2015. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm469571.htm. Accessed December 15, 2016.

When to refer

University of Minnesota Health Cancer Care specializes in unique therapies and procedures for melanoma, including phototherapy, photopheresis, Mohs surgery, and minimally invasive surgical approaches. For patients requiring advanced care, we offer isolated limb perfusion chemotherapy, chemoembolization, radioembolization, high-dose IL-2 therapy, and novel surgical options.

We work hard to keep you informed of your patients' care by providing detailed reports, from diagnosis to treatment and follow-up.

To schedule a cancer consultation, referral or appointment: 855-486-7226

For more information on clinical trials, visit studyfinder.umn.edu.

Collaborative Care

Many of our patients do not live within the Twin Cities metropolitan area. To minimize travel difficulties and lost time from school or work for our patients, we are committed to partnering with the patient’s referring provider and other local providers. Some patients can be initially discussed over the phone in collaboration with the referring provider. We aim to expedite the process so that, in one trip to the Twin Cities, patients can be assessed and also complete surgery, if required. In many cases, care after discharge can also be provided locally.

Physician Outreach Program

The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community.

To schedule a physician meeting or to visit our facility, contact Melinda Tuma, System Manager, Outreach Services. Phone: 612-867-3411; email: marvold1@fairview.org.

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