Treatment

	Flash Player is required to view this video. CancerSmart Web Cast March 22, 2007 -- Drs. Hadley Claire King, Kishwer Nehal, and Jedd Wolchok present "The latest developments in the screening and treatment of skin cancer." Total Run time: 55 minutes

Sentinel Lymph Node Biopsy to Rule Out Metastasis

Our physicians were among the first to use a procedure that can determine during surgery whether a melanoma tumor has spread to surrounding lymph nodes, and we now offer this as standard therapy when indicated.

The procedure -- known as gamma-probe-guided lymphatic mapping and sentinel lymph node biopsy -- uses a radiolabeled material to pinpoint the precise lymph node into which a nearby tumor would travel first, if it were to travel at all. That "sentinel node" can then be biopsied.

If the biopsy indicates metastasis, that lymph node and surrounding lymph nodes can be removed. But if there is no evidence of cancer spread, patients are spared further surgery on the lymph nodes.

Adjuvant Therapies for Patients at Risk for Recurrence

For patients who have been rendered free of disease by surgery but who are at risk for recurrence, Memorial Sloan-Kettering has led the development of innovative adjuvant (preventative) immunotherapy strategies intended to reduce the risk of cancer recurrence and prolong survival.

Investigators at Memorial Sloan-Kettering were among the first to develop and study monoclonal antibodies and vaccines that might help prevent spread or recurrence of a tumor in melanoma patients.

Researchers at Memorial Sloan-Kettering also pioneered types of DNA vaccines in the laboratory to trigger immune responses to melanoma. Cancer vaccines are now being studied for other types of cancer as well, including leukemias, breast cancer, ovarian cancer, prostate cancer, and sarcoma.

Find a Clinical Trial Find out about new research studies for melanoma more

New Strategies for Advanced Melanoma

For patients whose melanoma has spread regionally to nearby tissues or more broadly to other organs, we offer individualized programs, which may combine different treatments such as surgery, chemotherapy, radiation therapy, and immunotherapy. Many of these treatments are available through clinical trials only.

Isolated Limb Infusion

Australian researchers have reported success in treating recurrent melanoma that is confined to an arm or leg using a treatment called isolated limb infusion (ILI). Doctors at Memorial Sloan-Kettering are now evaluating this approach, in which high doses of chemotherapy drugs are administered by artery into the affected limb while blood flow is stopped temporarily with a tourniquet.

Although the ILI method of delivery is new, the drugs have been shown to be useful in treating melanoma. An older, more invasive method -- isolated limb perfusion -- required an operation on the blood vessels.

Blocking Genetic Mutations in Melanoma Tumors

Recently, researchers have established that 70 to 90 percent of melanomas have mutations in a metabolic pathway called MAPK. These mutations are responsible for turning on the MAPK pathway. Memorial Sloan-Kettering researchers are testing new drugs designed to turn off this pathway in order to stop the melanoma from growing.

Angiogenesis Inhibitors

Thalidomide was used in the 1950s in Europe as a sedative and anti-nausea drug. It caused profound birth defects when administered to pregnant women, and was taken off the market until it was approved for treatment of leprosy in 1996.

The drug is now known to stop the formation of new blood vessels (angiogenesis), and is thought to inhibit angiogenesis in tumors as well. Because thalidomide has relatively few serious side effects when taken by anyone other than pregnant women, it is being studied for treatment of several cancers including melanoma that has spread to the brain.

Cancer-Imaging Technologies

In a major research effort to improve the clinical management of metastatic melanoma, Memorial Sloan-Kettering doctors demonstrated the importance of positron-emission tomography (PET) scanning in addition to conventional imaging (CT scans) prior to surgery for patients with high risk melanoma.

Because PET scans allow imaging based on the increased metabolic activity of tumors compared to normal tissue, it is clear that this new technology will continue to play a critical role in treatment planning and assessment.

Melanoma Nomogram Our Melanoma Nomogram is designed to help physicians and patients decide which treatment approach will result in the greatest benefit go

Research to Detect Micrometastases

For early detection of possible spread of disease before surgery, Memorial Sloan-Kettering researchers are assessing techniques to detect individual melanoma cells that may have broken away from a primary tumor.

One such technique -- called reverse transcriptase polymerase chain reaction, or RT-PCR -- can detect one melanoma cell in 10 million circulating blood cells. The clinical significance of finding these cells in the bloodstream is being investigated.

Treatment of Ocular Melanoma

Uveal Melanomas

Memorial Sloan-Kettering doctors participated in a nationwide NIH-sponsored multicenter, prospective, randomized trial for uveal melanoma treatment. The trial demonstrated that with medium-sized melanomas, survival rates for treatment using radioactive plaques (brachytherapy) are essentially identical to rates for treatment using surgical removal of the eye (enucleation).

Our team of ophthalmic oncologists, radiation oncologists, and radiation physicists create individual plaques for each patient. The plaques are placed on the eye in an operating room while the patient is under monitored anesthesia care (MAC), which provides local or regional anesthesia while the patient receives sedatives to relax them during the operation.

Patients remain in the hospital for four nights, then have a second procedure to remove the radioactive plaque, again under MAC anesthesia. Patients are able to return home that same day. More than 90 percent of these patients are able to retain their eye.

Conjunctival Tumors

At Memorial Sloan-Kettering, we treat conjunctival melanoma and squamous cell carcinoma using combinations of micro-surgery, topical chemotherapy and cryotherapy (freezing). We recently introduced the use of a special laser that allows destruction of some of these cancers without surgery.

Orbital Tumors

Most tumors in the orbit, including lacrimal gland tumors, are benign and many require no treatment. For those benign tumors that require surgery, Memorial Sloan-Kettering uses a multidisciplinary approach, utilizing the skills of ophthalmic oncologists, head and neck surgeons, and neurosurgeons.

Malignant cancers do occur in the orbit, both primarily and secondarily. Among the more common tumors are lacrimal gland tumors (benign and malignant), hemangiomas, neurolemmoma, rhabdomyosarcomas and meningiomas. At Memorial Sloan-Kettering, we use combinations of surgery, radiation and chemotherapy for treatment of these cancers.