What to Expect
Pigmented Lesion Clinic
Our Pigmented Lesion Clinic offers the latest technology for monitoring changes in the shape and size of a pigmented skin lesion. We use digital cameras to take a series of 36 images of each patient. These images are then stored on a compact disc for future comparisons. Physicians can zoom to a specific spot on the body, enabling them to compare minute changes in a mole from one visit to another. They can also determine if new lesions have developed. A major benefit to the patient is that this is a very inexpensive procedure, costing less than a typical set of dental X-rays.
Another special strengths of our program is in the area of pathology. Our team includes two Dermatopathologists with specialty training in pathology of the skin. The expertise of these individuals allows us to distinguish malignant from benign tumors with the highest degree of accuracy. Accurately making this distinction is critical for proper management of each case.
Our pathology team can also facilitate BRAF and cKIT mutation testing of melanoma tumors at UNC. Knowing whether one of these mutations is present in the melanoma tumor provides information that can be used in making treatment decisions for the patient.
Surgery and Sentinel Lymph Node Biopsy
The treatment for melanoma depends upon the location, extent and stage of the disease. The depth to which the skin has been invaded determines the extent of the local surgical excision. When a large amount of skin is removed, grafting may be necessary. Skin may be taken from another part of the body and grafted to the area where the cancer was removed.
Approximately 20% of patients with melanoma have disease which has spread (metastasized) to the regional lymph nodes. To identify which patients have metastatic spread to the lymph nodes, a team of physicians from nuclear medicine, surgical oncology, and pathology performs a sentinel lymph node procedure. The sentinel node is the first lymph node draining the melanoma and is the one most likely to harbor metastatic disease if it exists. If the sentinel node is free of tumor, no additional therapy is necessary. If the sentinel node contains tumor, then a complete lymph node dissection is performed.
An additional strength of our program is the availability of Mohs Surgery for melanoma. Mohs Surgery is a highly specialized surgical procedure. Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin developed this surgical procedure more than 50 years ago.
Immunotherapy and Biologic Therapy
More information coming soon!
Novel Chemotherapeutics and Radiation Therapy
In cases in which the disease has spread to other parts of the body, we may also offer patients treatment with chemotherapy. We are committed to the development of improved treatments for all patients with melanoma and are currently studying a novel chemotherapy approach for this group of patients.
Radiation is sometimes used to treat local recurrences of melanoma that cannot be removed surgically. In cases in which the disease has spread to the lung, GI tract, bone, or brain, radiation may provide relief from symptoms.
Diagnosis and Evaluation
Depending on their situation, patients may see a surgical oncologist and/or a medical oncologist during their first clinic visit. We may prescribe a series of tests to stage the melanoma. Staging considers how deeply the cancer has penetrated the skin and tissue beneath the skin, how widely it has grown and whether it has spread to other parts of the body. Staging procedures may include a thorough physical examination, chest x-rays, blood tests, and liver function tests.
If the patient is seen by more than one specialist, these physicians will discuss the patient's case and work together to develop a treatment plan. The managing physician will discuss the treatment plan with the patient and answer any questions s/he might have. Patients may be offered the opportunity to participate in a clinical research trial if it appears that this would be a good option. Clinic staff will schedule any additional tests that are needed to complete the patient's evaluation. If surgery is required, a date will be set. Patients requiring chemotherapy will be instructed as to what to expect and how to manage care at home.
Arrangements may be made for the patient to meet support service providers. These might include a social worker, a financial counselor, a chaplain, a patient counselor, or a nutritionist, depending on the patient's needs and interests. Patients will have an opportunity to visit the Cancer Patient/Family Resource Center where they can obtain information about their diagnosis and learn about support groups and resources for individuals with cancer.
Certain individuals are at high risk for melanoma due to an inherited predisposition. Genetic counseling and testing can identify these individuals and assist in their medical decision making. Through our program, patients and/or their families can be evaluated for their genetic risk for melanoma. Arrangements are made for interested individuals to consult with a medical geneticist and genetics counselor. The results of the initial consultation are reviewed by the cancer genetics team, which includes the geneticist and counselor as well as medical oncologists and faculty members from the molecular diagnostics laboratory. This team will work together to develop a set of recommendations, which might include further testing and evaluation.
The nurse coordinator will follow the patient with the managing physician through all of his/her care at UNC. She will ensure continuity in the patient's care if s/he needs to see multiple cancer specialists and receive different types of treatment. Letters will be sent to the patient's local physician to inform him/her of the patient's treatment plan and status.