At Boston Medical Center (BMC), the care of patients with melanoma is a collaborative, multidisciplinary process, offering the full spectrum of services for early to advanced stages of the disease and involving dermatologists, specialized surgeons (including neurosurgeons and thoracic surgeons), medical oncologists, and radiation therapists. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits.
The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life. The NCCN Guidelines for treatment based on stage of disease are fully supported. In addition, clinical trials of new agents or combinations of agents are offered to try to prevent recurrence and to treat metastatic disease. Melanoma molecular tests and genetic screening are being used routinely to help direct and personalize treatments.
As the primary teaching affiliate of the Boston University Chobanian & Avedisian School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.
To schedule an appointment or refer a patient, call 617-638-7420.
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Conditions We Treat
Treatments & Services
Melanoma Surgery
The most common treatment for melanoma is a surgical procedure called a wide local excision. During this procedure the melanoma is completely removed together with a margin of the surrounding healthy skin. How much healthy skin is removed depends on the depth of the growth. The margin is examined under a microscope for any remaining cancer cells. If no cancer cells are found, no further surgery is necessary. Many times, a wide local excision can cure early-stage melanoma.
Mohs Surgery
Mohs surgery removes less healthy tissue than excisional skin surgery. The Mohs surgeon cleans and numbs the area of skin to be operated on. Then he or she removes the visible portion of the tumor and a very small margin of healthy skin. The Mohs surgeon examines the tissue under a microscope for cancer cells. If part of the tumor is still present, the Mohs surgeon carefully maps out the area where the tumor remains and only removes additional skin in the area where the margin shows the tumor. The process is repeated until the tumor is completely removed. This type of surgery is typically reserved for melanomas on the face where it is beneficial to conserve as much healthy skin as possible during surgery.
Reconstructive Surgery for Melanoma
If the surgeon is required to remove a large piece of skin in order to remove the melanoma in its entirety, a reconstructive surgical procedure may be required to close up the skin. This may involve removing skin from another part of the body, such as the upper thigh, to cover the site where the skin cancer was removed. This is called a skin graft. Alternatively, the surgeon may rotate a portion of skin from a neighboring area to cover the site. This is called a skin flap.
Lymph Node Dissection
If the physician performs a sentinel lymph node biopsy, and cancer is found in the sentinel nodes, it is likely a lymph node dissection will be advised to remove the other lymph nodes in the area.
Treatment for Advanced Metastatic Disease
The term metastatic disease refers to disease that has spread from its original site to distant organs in the body. At this advanced stage of the disease, it is unlikely that surgery can be used to cure the cancer, although it may be used to improve a patient’s quality of life and help him or her live more comfortably.
Chemotherapy
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).
Immunotherapy
For patients with advanced-stage melanoma, immunotherapy may improve the body’s natural immune response to cancer. Immunotherapy recruits the body’s own immune system and uses it to fight cancer all over the body, making it difficult for cancer cells to hide or develop defenses against it. Immunotherapy has the potential to keep working even after the patient has completed treatment.
Targeted Therapy
Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. Usually, targeted therapy does less damage to normal cells than other cancer treatments.
Drugs that target melanomas carrying C-KIT gene mutations
Mast/stem cell growth factor receptor (SCFR) is a protein in humans that is encoded by the KIT gene. Active mutations in this gene are associated with a small percentage of melanomas. C-KIT mutations also help the melanoma cells to grow and divide more quickly. The mutations are commonly found in melanomas that originate on the palms of the hands, the soles of the feet, or underneath the fingernails (called acral melanomas); inside the mouth or other mucosal (wet) areas; and on parts of the body chronically exposed to the sun.
Cytokines
Cytokines are proteins in the body that activate the immune system. Interferon and interleukin-2 (IL-2) are man-made versions of cytokines that are sometimes used to treat patients with advanced-stage melanoma. Interferon is injected intravenously or under the skin and can slow the growth of melanoma cells. It may be offered in addition to surgery for patients with melanoma that has spread to regional lymph nodes (Stage III disease) in order to help prevent further spread of the disease and help prolong survival.
Isolated Limb Perfusion
In rare cases, melanoma may spread as multiple deposits to the skin that are local to the original melanoma. Isolated limb perfusion is a localized form of chemotherapy used for treating these multiple metastatic melanomas that have spread to the skin on one arm or one leg. The treatment allows high doses of the chemo drug to be administered to the cancer site without endangering the rest of the body. It separates the blood flow of the limb with cancer from the rest of the body for a short period of time. During this period, high doses of the chemo drug are given into the limb.
Radiation Therapy
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).
IMRT
Intensity-Modulated Radiation Therapy (IMRT) is a type of external beam radiation therapy that delivers beams of radiation customized to the shape and size of the tumor. Unlike 3D-CRT, which delivers the same amount of radiation to both the tumor and the surrounding tissue, the intensity of the beams can be adjusted (modulated) for IMRT, enabling the radiation oncologist to deliver different amounts of radiation to different areas of the tumor and the surrounding tissue. This allows the radiation oncologist to deliver the maximum amount of radiation to the tumor while sparing the surrounding healthy tissue.
CyberKnife
CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.
Diagnostics and Tests
Personal and family medical history
Your doctor will likely ask you a series of questions relating to your personal medical history and your family's medical history.
Physical Exam
Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.
Skin Biopsy
For a skin biopsy, the physician may remove part or all of the skin in the area of concern, so it can be thoroughly examined under a microscope by a physician called a pathologist. The skin around the area being biopsied will be numbed using a local anesthetic before the biopsy. The anesthetic may sting slightly as it enters the body, but you should feel no pain during the biopsy itself.
Shave Biopsy
A sharp, thin blade is used to shave off the abnormal growth. To stop the biopsied site from bleeding, the physician applies an ointment or cauterizes the wound with a small electric current.
Punch Biopsy
The physician uses a sharp, hollow, round tool to remove a circle of tissue from the area of concern. The physician rotates the tool on the surface of the skin until it cuts through all of the different layers of skin and removes a tissue sample. This allows for better sampling of the depth of the lesion. The edges of the skin are typically stitched together following the biopsy.
Incisional Biopsy
A scalpel is used to remove part of the growth.
Excisional Biopsy
A scalpel is used to remove the growth in its entirety and some of the surrounding tissue. Excisional biopsies are generally performed on growths that appear to be melanomas.
Fine Needle Aspiration (FNA) Biopsy
FNA uses a thin, hollow needle (thinner than the needles used to draw blood) to draw out fluid or tissue from a lump. Depending on the size and location of the lump, the needle is sometimes directed into the lump simply by feeling it. Other times it may be guided into the lump with the assistance of an ultrasound.
Surgical (excisional) lymph node biopsy
The physician removes an enlarged lymph node through a small cut in the skin. If the lymph node is close to the surface of the skin, a local anesthetic will be used to numb the area being biopsied. If it is located deep under the skin, you may be given drugs to make you drowsy or be put to sleep (using general anesthesia). Surgical lymph node biopsies are generally performed if the lymph node’s size indicates the melanoma has spread, but an FNA was not performed or did not yield conclusive results.
Sentinel lymph node biopsy
If a patient has been diagnosed with melanoma, a sentinel lymph node biopsy may be performed to see if the disease has spread to nearby lymph nodes at a microscopic level (i.e., the lymph nodes are not enlarged on the exam but contain small numbers of melanoma cells that have spread from nearby skin).
Lab tests for Melanoma
In cases of advanced melanoma, physicians may perform tests on a biopsy specimen to see if certain genes in the cancer cells are mutated, as this may help determine which treatment options will work best for the patient.
Chest X-ray
Chest x-rays provide an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area. They can be used to look for broken bones, diseases like pneumonia, abnormalities, or cancer.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.
Magnetic Resonance Imaging (MRI)
This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple planes. Some people may need an IV put in place so caregivers can inject a contrast solution into their veins. This depends on the exam the doctor has ordered. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream.
Melanoma Blood Tests
Physicians may perform certain blood tests before or during treatment. For example, physicians frequently test for levels of lactate dehydrogenase (LDH) in the blood prior to treatment. Melanoma may be more difficult to treat in patients with elevated levels of LDH, particularly if the disease has spread to distant sites in the body.
Our Team
BMC’s comprehensive melanoma team includes physicians who work in dermatology, dermatopathology, surgical oncology, medical oncology, radiation oncology, plastic surgery, and head and neck surgery. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.
Surgical Oncologists
Michael R Cassidy, MD
Teviah E Sachs, MD, MPH
Physician Assistants
Kelsey J Burke, PA-C
Kayla McDonald, PA-C
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