Advances in surgery are improving survival for people with melanoma

By Mayo Clinic staff

The National Cancer Institute estimates that 97,610 people will be diagnosed with melanoma in 2023, making up 5% of all new cancer diagnoses. Fortunately, screening and treatment have improved, allowing care teams to catch melanoma earlier when it's easier to treat. As a result, the number of people who survive the disease has steadily increased.

Tina Hieken, M.D., a Mayo Clinic surgical oncologist with a particular interest in melanoma, answers questions about treatment and advances in surgery that are helping to improve outcomes for people diagnosed with the disease:

Who is diagnosed with early-stage melanoma?

We have seen a shift over the last several decades to an increase in people being diagnosed with earlier-stage disease, along with an overall increase in the incidence of melanoma. Melanoma has historically been one of the most rapidly increasing cancers, but this has varied by age. In adults age 50 and older, rates continue to grow in women by about 1% a year but have stabilized in men. As the population ages, the average age at diagnosis of melanoma is closer to age 60; however, melanoma is one of the most common cancers in adults younger than 30.

What are some important considerations in treating early-stage melanoma?

Finding melanoma at its earliest stage allows us to treat the lesion with surgery — without using systemic therapies that reach and affect cells throughout the body, creating potential toxicities and side effects. But even the earliest stage of the disease requires a specialized, multidisciplinary care team to ensure the patient has the best treatment options, as melanoma care is evolving rapidly. The melanoma care team at Mayo Clinic includes surgical oncologists, medical oncologists, radiation oncologists, dermatologists, radiologists and pathologists. We work together and with other scientists to bring research advancements into care as quickly as possible.

How has research advanced the treatment of early-stage melanoma in recent years?

At Mayo Clinic, we have many open clinical trials in which we're applying new ideas to patient care:

• One study is enrolling patients with stage 1 and 2 melanoma to evaluate whether a melanoma gene signature developed at Mayo Clinic can predict a patient’s sentinel lymph node status. A sentinel lymph node is the first lymph node to which cancer cells spread from a primary tumor. A sentinel node biopsy is often performed to accurately stage patients whose disease appears not to have spread beyond the skin. During the procedure, the sentinel node is removed and a pathologist examines it under a microscope to see if there is evidence that the melanoma has spread. This study aims to determine if a melanoma gene signature can help determine which patients may benefit from sentinel node surgery and which patients may safely avoid it.  
• Another study is testing the injection of a type of immunotherapy directly into the tumors of patients with melanoma that involve soft tissue.
• We also are testing new treatments given by injection through a vein for patients with more advanced disease that has spread to the lymph nodes but can still be removed with surgery. These new combinations of drugs are given to patients with a high risk of disease recurrence following surgery.
• For patients with high-risk disease that can be treated with surgery, we are investigating neoadjuvant systemic therapy. Neoadjuvant systemic therapy uses substances that travel through the bloodstream and is given before surgery to shrink tumors. We have a clinical trial testing new immunotherapy combinations for melanoma patients whose cancer has spread to nearby lymph nodes.

How might surgery help a patient with later-stage melanoma?

While we typically think of surgery as an option primarily for early-stage disease, surgical oncologists are increasingly involved in caring for patients with advanced disease. For example, some patients may have a mixed response to systemic therapy and a surgical oncologist will remove any remaining cancer with surgery.

Surgeons may also remove tumors to obtain active immune cells for cellular therapies being tested in clinical trials. We anticipate that these treatments will become approved for clinical use soon.

Surgical oncologists work with the multidisciplinary team to create the best possible treatment plan for each patient. Ultimately, it's all about bringing all the right people into a patient's care team. When working together, we can assess treatment responses and make changes quickly. We work together to provide the best personalized options for patients with melanoma.

Learn more

Watch this video to hear more about how surgery is used to treat melanoma at Mayo Clinic.

Learn more about melanoma and find a melanoma clinical trial at Mayo Clinic.

Join the Skin Health Support Group on Mayo Clinic Connect, an online community for patients to get answers, ask questions and connect.

Also, read these articles:

• "Treating skin cancer with Mohs surgery"
• "Melanoma misconception — dark skin tones at risk, too"
• "Cancer-free and embracing new adventures thanks to Mayo’s collaborative care"
• "Why men need to take melanoma seriously"
• "Dawn’s journey: Overcoming a near-zero survival rate"
• "Melanoma spread: How lymph nodes play a role in detection"
• "Is a cancer clinical trial right for me?"

A version of this article was originally published on the Mayo Clinic Medical Professionals website.