Editorial,  Clin Oncol Case Rep Vol: 6 Issue: 8

Melanoma Review: Exploring Recent Advancements

Carlos A. Cardenas^*

Department of Oncology, Foundation for Research and Sciences (FORESC), USA

*Corresponding Author: Adamantia Nikolaidi,
Department of OncologyFoundation for Research and Sciences (FORESC), USA.
E-mail: Karmed@live.com

Received: August 04, 2023; Manuscript No: COCR-23-113170;
Editor Assigned: August 08, 2023; PreQC Id: COCR-23-113170 (PQ);
Reviewed: August 14, 2023; QC No: COCR-23-113170 (Q);
Revised: August 20, 2023; Manuscript No: COCR-23-113170 (R);
Published: August 28, 2023; DOI: 10.4172/cocr.6(8).309

Citation: Cardenas CA (2023) Melanoma Review: Exploring Recent Advancements. Clin Oncol Case Rep 6:8

Abstract

Editorial

Melanoma is a critical issue in the field of Dermatology-Oncology, accounting for a significant portion of skin cancer deaths worldwide. In 2023, it is estimated that there will be approximately 106,110 new cases of melanoma and 9,940 deaths from melanoma in the United States alone1. These numbers highlight the urgent need for improved diagnostic and prognostic techniques that can support personalized care and treatment strategies to improve patient outcomes.

Fortunately, advancements in melanoma are emerging that have immense potential to revolutionize diagnosis and prognosis. One of the critical novelties is the use of molecular techniques such as Next-Generation Sequencing (NGS). This technology has shown immense potential in detecting genetic alterations and mutations and predicting treatment responses to therapies like immunotherapy and targeted therapy. NGS can also help identify drug targets that can aid in developing personalized therapeutic options for patients.

Alongside NGS, another promising development is the use of AI and machine learning algorithms to overcome the limitations of conventional diagnostic and prognostic methods 2. These algorithms can analyze images, and clinical and genetic data, and recognize patterns that the human eye cannot identify. AI can significantly improve diagnosis and prognosis while minimizing inter-observer variability, making it a valuable part of clinical decision-making processes [1].

Lastly, biomarker identification and RNA signatures associated with melanoma progression and treatment response are emerging as critical advancements in the field. Several genes and proteins like SOX10, PD-L1, IDH2, and MITF have been found to be closely linked to melanoma progression and responsiveness to treatment [2] Additionally, RNA signatures in tumor and immune cells can help predict how patients will respond to immunotherapy with anti-PD-1 and anti-CTLA-4 drugs [3].

Radiation therapy entails the utilization of high-energy X-rays or other particles to eradicate malignant cells. The predominant modality is external-beam radiation therapy, which is administered externally via a machine positioned outside the body, affording precise localization and mitigation of adverse effects. The therapeutic regimen, including the number of sessions and radiation dosage, is determined by a radiation oncologist.

In instances where melanoma has metastasized, inducing symptoms such as osseous discomfort or cephalalgia, radiation therapy may be indicated to alleviate these manifestations. This particular approach is denominated as palliative radiation therapy. For certain patients, palliative radiation therapy encompasses the administration of multiple modest radiation doses to an entire organ, exemplified by whole-brain radiation therapy. Alternatively, singular or a few elevated doses of radiation therapy are delivered using advanced technologies like a linear accelerator (referred to as "linac"), Gamma Knife, CyberKnife, or TomoTherapy unit. This specialized technique is recognized as stereotactic radiosurgery, stereotactic ablative radiation therapy, or stereotactic body radiation therapy, and it is generally most efficacious for the treatment of isolated or limited tumors within the cranial or extracranial regions.

It is pertinent to acknowledge that radiation therapy finds application in diverse clinical contexts, encompassing adjuvant therapy following surgical intervention to forestall local recurrence and cases where cancer is unresectable in lymph nodes or cutaneous tissues. Ongoing research is also exploring the synergy of radiation therapy with pharmacological agents for melanoma management. Conventional side effects associated with radiation therapy encompass cutaneous irritation, asthenia, and site-specific effects contingent on the treated area, such as oral mucosal irritation or lymphedema. Typically, these adverse effects can be ameliorated through the application of topical corticosteroid creams and antibiotics. Patients are encouraged to consult a radiation oncologist to deliberate potential side effects and their mitigation.

Melanoma medication treatment categories

Enhancing the Immune Response: Immunotherapy strategies leverage the body's own immune system to combat melanoma. Several variants exist:

• Blocking PD-1 and PD-L1 proteins: Medications such as nivolumab (Opdivo) and pembrolizumab (Keytruda) inhibit the PD-1 protein, augmenting the immune system's capacity to identify and eliminate melanoma cells [4].

• Counteracting CTLA-4 molecule: Ipilimumab (Yervoy) targets CTLA-4, demonstrating effectiveness in diminishing melanoma tumors and improving survival prospects [4].

• Synergistic immunotherapies: Combining agents like ipilimumab and nivolumab or nivolumab and relatlimab (Opdualag) is employed to curtail tumor growth and, though associated with increased side effects, can yield positive outcomes[4].

• Interleukin-2 (IL-2): Activating T cells, IL-2 is used for select cases of metastatic melanoma, albeit with the caveat of severe side effects [4].

• Viral-based therapy: Talimogene laherparepvec (T-VEC) is a virus therapy administered directly into melanoma tumors, activating the immune system and eradicating cancer cells [4].

Precision targeting: Targeted therapy specifically addresses genetic or molecular aberrations within melanoma cells, including:

• BRAF inhibition: Agents like vemurafenib (Zelboraf) are designed to counteract the BRAF mutation commonly encountered in melanoma [4].

• MEK inhibition: Cobimetinib (Cotellic) is an MEK inhibitor frequently employed in combination with other precision therapies [4].

• Cytotoxic treatment: Although less prevalent, chemotherapy remains a treatment option, involving the use of medications to obliterate malignant cells [4].

• Integrated therapeutic approaches: Certain melanoma treatment plans incorporate a blend of the aforementioned modalities, personalized according to the patient's specific condition and the melanoma stage [4].

These diverse treatment avenues offer a spectrum of choices for individuals affected by melanoma. The selection hinges on variables such as the disease stage, genetic mutations, and the unique characteristics of each patient. It is imperative for patients to engage in discussions with their healthcare professionals to determine the most suitable and effective treatment regimen.

Surgery plays a pivotal role in the management of melanoma, a malignant skin cancer, and is typically conducted by specialized surgical oncologists. The primary objective of surgical intervention in melanoma is the complete removal of the tumor while ensuring the excision of a margin of healthy tissue surrounding it. The selection of a particular surgical approach is contingent upon several factors, foremost among them being the stage of the disease and the individual patient's risk of recurrence.

Diverse surgical modalities for melanoma

Wide excision:

• The cornerstone of melanoma surgery involves wide excision, primarily targeted at removing the primary melanoma lesion on the skin. The extent of this excision is intricately linked to the melanoma's thickness.

• In cases where melanomas measure less than 1.0 mm in thickness, outpatient surgery is often deemed sufficient. This surgical procedure encompasses the removal of the malignant tumor, the subcutaneous tissue, and a carefully calculated margin of healthy surrounding tissue to ensure the complete eradication of cancer cells.

• The margin's width is progressively adjusted, increasing from 1 cm for melanomas measuring up to 1.0 mm to 2 cm for those exceeding 2 mm in thickness. Furthermore, depending on the location and scale of the surgery, adjunctive measures such as skin flaps or grafts may be deemed necessary to optimize postoperative outcomes [4].

Lymphatic mapping and sentinel lymph node biopsy

• Lymphatic mapping and sentinel lymph node biopsy represent a sophisticated surgical technique aimed at identifying lymph nodes most susceptible to melanoma infiltration. This procedure involves the injection of a specialized dye and a radioactive tracer around the melanoma site.

• By discerning the sentinel lymph nodes that uptake the dye and/or radioactive tracer, surgeons can meticulously assess them for the presence of melanoma cells. Should these nodes exhibit an absence of melanoma cells, the necessity for further lymph node surgery is obviated.

• This procedure is conventionally advocated for melanomas with a thickness exceeding 0.8 mm or those featuring ulceration. Nevertheless, select cases involving thinner melanomas may warrant sentinel lymph node biopsy, contingent on various associated risk factors [4].

Lymph node dissection

• The revelation of melanoma cells in sentinel lymph nodes, denoting metastasis, previously prompted the recommendation of Complete Lymph Node Dissection (CLND). However, contemporary research underscores the limited impact of CLND on patient survival.

• Instead, current medical practice inclines toward rigorous monitoring through a regimen of physical examinations and diagnostic imaging modalities, such as ultrasound scans. The extent of lymph node removal is contingent upon the anatomical region of involvement.

• It is noteworthy that CLND can entail an extended recovery period and heightened susceptibility to side effects, particularly lymphedema, which is notably prevalent when CLND is performed in proximity to extremities [4].

Clinical considerations

• Surgical decision-making is underpinned by various parameters, including melanoma thickness, ulceration status, and associated risk factors.

• The concomitant performance of lymphatic mapping and sentinel lymph node biopsy with wide local excision is favored, as it mitigates the necessity for multiple surgical interventions.

• In situations where an enlarged lymph node is identified during clinical examination or imaging studies, physicians typically advocate for a biopsy and comprehensive staging evaluations. The presence of melanoma is confirmed, and if no further evidence of metastasis is ascertained, lymph node dissection may be recommended to ensure the thorough removal of compromised lymph nodes [4].

Updated 08/2023 melanoma treatment by stage

Stage 0 melanoma:

• Intervention: Predominantly surgical, specifically wide excision.

• Rationale: At this incipient stage, surgical excision remains the principal modality to effectuate melanoma removal.

Stage I melanoma:

• Intervention: Surgical extirpation of the primary lesion, often accompanied by contiguous healthy tissue excision. Additionally, lymph node mapping and potential lymph node dissection.

• Rationale: Surgical intervention constitutes the cornerstone of treatment, accompanied by the consideration of regional lymph node assessment to ascertain potential dissemination [4].

Stage II melanoma:

• Intervention: Surgical resection of the primary lesion and adjacent tissue. Concurrently, intraoperative lymphatic mapping and sentinel lymph node biopsy are conducted. For stages IIB and IIC, collaborative consultation with a medical oncologist is advisable to deliberate adjuvant therapeutic prospects involving pembrolizumab or nivolumab. The contemplation of participation in clinical research endeavors is also pertinent [4].

• Rationale: Surgical excision remains the principal treatment modality, with adjunctive consideration of adjuvant therapies and participation in clinical trials for certain cases.

Stage III melanoma (resectable):

• Rationale: Stage III melanoma is characterized by regional dissemination, either through local expansion or lymphatic dissemination. Treatment stratagem is contingent upon the potential resectability of the melanoma lesion and the conceivable inclusion of adjuvant or neoadjuvant therapeutic regimens [4].

Adjuvant therapy:

• Intervention: Postoperative pharmacological intervention intended to mitigate cancer recurrence risk, encompassing the application of immunotherapy or targeted therapy over a duration of one year.

• Rationale: Following primary melanoma excision and potential lymph node evaluation, adjuvant therapy serves the purpose of diminishing the likelihood of disease recurrence [4].

Neoadjuvant therapy:

• Intervention: Preoperative administration of pharmaceutical agents, such as immunomodulatory or targeted therapy.

• Rationale: Preoperative therapeutic measures are undertaken with the objective of enhancing therapeutic outcomes. Recent research findings underscore the potential efficacy of administering pembrolizumab both prior to and subsequent to surgery, particularly for patients diagnosed with advanced stages [4].

Clinical trials:

• Rationale: Clinical trial enrollment stands as a viable consideration across all stages, warranting discussion with healthcare providers to explore available investigational opportunities tailored to the patient's clinical context [4].

It is imperative to underscore that treatment protocols are meticulously individualized in accordance with the specific diagnosis and clinical requisites of each patient. Thus, diligent consultation with healthcare practitioners is indispensable for the formulation of an optimal therapeutic strategy.

In addition to the physical burden of melanoma, patients may also experience emotional and mental health challenges that can lead to burnout and depression [5]. The diagnosis of melanoma can spark anxiety and fear, and the treatment journey can be grueling, with frequent check-ins, procedures, and appointments. Patients may also need to make lifestyle changes to avoid sun exposure and other environmental factors that can trigger the disease. These challenges can take a significant toll on a person's mental and emotional wellbeing, leading to burnout and depression. It is critical to address the mental health challenges that come with melanoma, providing access to counseling and support groups that can help patients cope with the emotional toll of the disease. By recognizing the psychological impact of melanoma and providing holistic care, we can improve the quality of life for patients.

Key insights into melanoma

• Incidence and mortality rates: The rate of new cases of melanoma of the skin in the United States was approximately 21.0 per 100,000 men and women per year. It is estimated that 97,610 new cases of melanoma will be diagnosed in 2023, with about 58,120 cases in men and 39,490 cases in women. The death rate from melanoma is approximately 2.1 per 100,000 people [6].

• Gender disparities: Melanoma affects both men and women, but there is a higher incidence rate in men. In 2023, it is estimated that 5,420 men and 2,570 women will die from melanoma [7].

• Causes: The vast majority of melanomas are caused by exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. Other risk factors include fair skin, a history of sunburns, a family history of melanoma, and a large number of moles on the body[8].

• Global impact: Melanoma is a major public health problem worldwide. In the United States alone, it is projected that 1,958,310 new cancer cases, including melanoma, will be diagnosed in 2023 [9].

• Rising trends: Melanoma rates have been increasing over the years. In the UK, for example, melanoma skin cancer cases are projected to rise by 9% between 2023-2025 and 2038-2040 [6].

Conclusion

The continued emergence of new technologies, biomarker identification, and RNA signatures have the potential to transform melanoma pathology and further advance the field of dermatology. By validating these techniques, we can pave the way for early diagnosis, personalized treatments, and improved outcomes for melanoma patients physically and mentally. With the ongoing research and development efforts, we can strive towards reducing the burden of melanoma in the upcoming years.

References

1. Skin Cancer Statistics.World Cancer Res Fund Intern.
2. AACR Annual Meeting (2023): Therapy Advances for Patients With Rare Melanoma Types  . Am. Assoc. Cancer Res.
3. Cazzato, G (2023). Histopathological Diagnosis of Malignant Melanoma at the Dawn of 2023: Knowledge Gained and New Challenges. Dermatopathology, 10(1), 91-92. [Google Scholar]
4. Melanoma - Types of Treatment. 2012. Cancer Net
5. Cardenas, C (2022). Extinguising the unknown from Burnout. Arch. Patol, 3(3), 87 [Google Scholar]  
6. Melanoma of the Skin - Cancer Stat Facts.
7. Melanoma - Statistics. 2012. Cancer Net
8. Skin Cancer Facts & Statistics. Skin Cancer Facts & Stat.
9. Clancy, E. (2023). ACS Report Shows Prostate Cancer on the Rise, Cerv. Cancer Decline, Ren. Urol. News.[GoogleScholar]