Melanoma on the rise; early detection key
Melanoma is the most rapidly increasing cancer diagnosis in the United States, and Ohio consistently ranks as the state with the fifth or sixth highest number of melanoma diagnoses.
At MetroHealth, melanoma is the third most diagnosed cancer, behind lung and breast cancer.
“We see a great deal of melanoma in the area and have a lot of experience treating it. When caught early, melanoma survival rates are good,’’ said surgical oncologist Bruce J. Averbook, MD, FACS. “Since 1972, we’ve developed a large database on melanoma and are keeping track of patients we have seen and have published studies based on this.”
Dr. Averbook pointed out that MetroHealth has a very strong dermatopathology group, essential because many decisions in melanoma treatment are based on a good working relationship between pathology and surgery.
“There are ambiguous areas, making it difficult to determine is it a melanoma or not, and how is it going to behave,’’ he explained. “For instance, atypical melanocytic neoplasms can be very difficult to interpret. These potentially ambiguous melanocytic lesions are some of the most difficult and controversial areas in dermatopathology that affect treatment by surgical oncologists.’’
Melanoma risk increases with age, although Dr. Averbook notes that melanoma numbers are increasing among younger people. He is particularly worried about the use of tanning beds and their impact on this growth.
While the majority of melanoma patients he sees are adults, Dr. Averbook has had pediatric patients, has helped develop an international database on melanomas in children and has written papers on the topic.
Dr. Averbook is the Case Western Reserve University Principal Investigator for the Eastern Cooperative Oncology Group, as well as a member of ECOG’s Melanoma Core Committee and the ECOG Surgery Core Committee. He trained with Steven A. Rosenberg, MD, an internationally recognized pioneer in treating melanoma and current chief of surgery at the National Cancer Institute.
Surgery is the most important treatment for melanoma. Specially trained melanoma surgeons are experienced at ensuring there are adequate margins around the primary tumor to decrease risk of local recurrence.
In addition, said Dr. Averbook, judgment and the decision to selectively evaluate the draining lymph node basin by sentinel lymph node biopsy is critical to determining prognosis and patient treatment. Sentinel lymph node biopsy is a method to map out the location of the draining lymph nodes and remove the first one that a tumor may have traveled to.
Dr. Averbook is MetroHealth’s principal investigator on a clinical trial examining the feasibility and safety of minimally invasive inguinal lymph node dissection in patients with melanoma. He trained for the surgical trial at the Mayo Clinic and hopes to be offering the surgery to candidates starting this summer.
“We take out lymph nodes through videoscopic techniques, with three small incisions rather than one long one. It appears to be less traumatic for the patient’’ and, hopefully, will lead to quicker recoveries.
MetroHealth also offers melanoma patients the chance to be part of cutting-edge treatment through other clinical trials.
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