Melanoma Treatments at MedStar Georgetown Cancer Institute

Melanoma Treatment at MedStar Georgetown Cancer Network

We offer a full range of effective treatments for melanoma. Early-stage melanomas can often get treated effectively with surgery alone, but more advanced cancers often require other approaches. Sometimes more than one treatment type is needed.

Options depend on:

  • The melanoma’s thickness, stage, rate of growth, and any genetic changes
  • Whether it has spread
  • Possible side effects
  • Your overall health
  • Your preferences

Meet the Melanoma Team

Melanoma Multidisciplinary Team

Across the top: Arash Radfar, MD- dermatopathology, Waddah Al-Refaie- Chief of Surgical Oncology, Surgeon in Chief Georgetown-Lombardi, MBA, Michael Reilly, MD- ENT and Plastic Surgery, Matt Goldberg, MD, Dermatology and Derm Path, Suthee Rapisuwon, MD, Medical Oncology, Clinical Genetics, Geoffrey Gibney, MD Medical Oncology, Co-leader MGCN Melanoma Disease Group Sitting: Dorothy Kavanaugh RN- Nurse Coordinator, Kellie Parks NP- Nurse Practitioner, Helena Pasieka, MD, Dermatology.

Surgery

Many melanomas are cut from the skin quickly and easily, with no further treatment needed — in fact, many times the disease is removed during the initial biopsy. If surgery is needed, our expert doctors provide several types:

  • Wide Local Excision: Excision is our standard approach, removing the cancer and up to two centimeters of surrounding tissue, with the amount and the degree of scarring dependent on the tumor’s thickness.
  • Mohs Micrographic Surgery: During Mohs surgery, the cancer is shaved off one thin layer at a time and checked under a microscope. Such a procedure is helpful when the tumor:
    • Has an unknown shape and depth
    • Is large
    • Has returned
    • Is located in a hard-to-treat spot, especially in the head and neck

Only doctors who are specially trained should perform Mohs surgeries, and we offer this expertise.

Lymph Node Mapping and Biopsy

In some cases, our doctors may recommend a sentinel lymph node biopsy with lymphatic mapping (lymphoscintigraphy) before surgery. During this minimally invasive procedure, the doctor injects a dye and a (safe) radioactive substance at the site of the cancer, then watches to see which lymph node it migrates to first—the sentinel lymph node.

The lymph node is biopsied; if found clear, no further action is required. If it is not found clear, one or more lymph nodes may need to be removed—a surgery called dissection or lymphadenectomy. Learn more about specialized skin cancer procedures. 

Reconstruction and Grafting

Sometimes melanoma is located in a cosmetically sensitive area, or the doctor had to remove a large amount of tissue. If that’s the case, your dermatologic oncologist will partner with one of our expert plastic surgeons when the surgery is still in the planning stage.

After the surgery, the plastic surgeon repairs any visible scars. For larger tumors, the surgical site is reconstructed with a skin graft, taken from a discreet place elsewhere on your body. The team works hard to ensure you are happy with the final results.

Radiation

Our experienced radiation oncologists partner with our dermatologic oncologists to deliver the latest melanoma radiation therapy — high-energy rays or special radioactive sources that damage cancer cells and stop them from growing.

  • External Beam Radiation Therapy: External beam radiation uses a large machine to aim high-energy radiation beams at your cancer from outside your body. Our specialists treat as small an area as possible to avoid causing unnecessary damage to your healthy tissue.
  • High-Dose Rate (HDR) Brachytherapy: This is a method of brachytherapy that delivers radiation to the lesion at the surface of the skin. In HDR brachytherapy, a radioactive wire is attached to a highly specialized robotic machine. The robotic machine carefully guides the delivery of the radiation directly into the tumor and removes the wire after the session.
  • Total Skin Electron Therapy: Rotational Total Skin Electron Therapy (RTSEI) and static Total Skin Electron Irradiation (TSEI) are advanced approaches to treating this skin disorder. During TSEI, a patient's entire skin is treated with low-energy electrons. This radiation penetrates very superficially, protecting internal organs and other structures.

Skin cancers respond well to radiation therapy, and we may recommend it when:

  • You’ve had surgery for a type of melanoma called desmoplastic melanoma.
  • The cancer is located in a place that’s hard to treat with surgery, such as the eyelids, tip of the nose or ears.
  • Lymph nodes were removed and there’s a risk the cancer could come back.
  • The cancer has returned to the skin or lymph nodes after surgery.
  • The cancer has spread.

Chemotherapy

Melanoma is often resistant to chemotherapy, and targeted therapy is usually a better choice when the disease has advanced. But chemotherapy can help relieve symptoms or extend survival for some patients; it can also help save limbs in some cases.

Our doctors have the skill and experience needed for complex procedures that temporarily cut off circulation to an arm or leg, then deliver chemotherapy just to that limb. Such treatment can save the limb and is often recommended when melanoma has returned to that area, with a number of confined tumors that are untreatable with surgery. There are two approaches:

  • Hyperthermic Isolated Limb Perfusion (HILP): HILP involves surgery and heats the chemotherapy’s route to make it more susceptible to the drugs.
  • Isolated Limb Infusion (ILI): ILI is not a surgery, but a minimally invasive procedure that uses catheters threaded through a small incision into veins and arteries. The procedure is shorter, and easier on frail and elderly patients, as well as in cases where a patient might need more than one treatment.

Both approaches provide advantages when compared to delivering systemic chemotherapy throughout the body:

  • Higher doses than could otherwise be given
  • More effective in such cases
  • Avoid amputation

We continue to explore new chemotherapy options in clinical trials, including the possibility of identifying each melanoma’s particular resistance and susceptibility.

Targeted Therapy or Immunotherapy

Targeted therapy represents a new way to treat melanoma, encouraging your own immune system to fight the cancer or focusing on specific genetic changes that help the disease grow. Targeted therapy is typically an option for advanced melanoma, though one drug, the synthetic protein Interferon, is occasionally given after surgery.

Sometimes targeted therapy works when chemotherapy doesn’t, and sometime the two treatments are paired together in a new approach called biochemotherapy. Targeted therapy represents a promising front for melanoma treatment, and appropriate patients may qualify for one of our clinical trials. Drugs that are already approved include those that:

  • Target Genetic Changes: Given as pills
  • Help the Immune System (Immunotherapy): Given as an IV infusion or an injectable vaccine, boosting the immune system or removing proteins that normally keep it in check

Melanoma Follow-Up Care

Your physician will want to see you every three to six months following your treatment. You may need to repeat any of the diagnostic tests to make sure the cancer is not returning.

Malignant melanoma can return after treatment. To protect yourself from a recurrence, you should:

  • Stay out of the sun, especially during the hottest hours of the day
  • Always protect your body from the sun with hats, long sleeves, sunglasses and sunscreen
  • Regularly check your skin for new or changing moles or other marks