Metastatic Melanoma

Melanomas are the most aggressive form of skin cancer.

Fortunately, most melanomas are discovered at an early stage when they are highly curable by surgery alone. According to data from the U.S. Surveillance, Epidemiology, and End Results program, 84 percent of cutaneous melanomas are discovered while localized, and for these patients, the 5-year relative survival rate is 98 percent.

Patients whose melanoma has spread to regional lymph nodes (stage 3; about 8 percent of cases) have a 5-year relative survival rate of about 62 percent, and patients whose cutaneous melanoma is unstaged at diagnosis (about 4 percent of cases) have a 5-year relative survival rate of 76 percent. Patients who present with metastatic disease (stage 4; about 4 percent of cases) have a 5-year relative survival rate of about 16 percent.

It is important to recognize that these percentages are average numbers and may not be applicable in all patients. It is also important to remember that recent advances in the treatment of melanoma may make these numbers obsolete. It is important to learn from your doctor what your personal outlook is, based on the specific characteristics of your case.

Although most melanomas occur on the skin surface, approximately 7 percent of primary melanomas are non-cutaneous, starting somewhere other than on the skin surface.

  • Non-cutaneous melanomas occur most often in the eye and mucous membranous sites such as the anus, rectum, vulva, vagina, nasal sinuses, and mouth. These tumors are associated with poorer prognoses than are cutaneous melanomas.
  • Non-cutaneous melanomas tend to go undetected until they reach an advanced stage because they are hidden deep in the eye or in mucosa, where they cause no early symptoms. These locations also offer access to relatively rich vascular and/or lymphatic environments, enabling non-cutaneous melanomas to spread more quickly than their cutaneous counterparts. Genetic differences between cutaneous and non-cutaneous melanomas cause them to have different biological behaviors and to respond differently to treatment.

The current standard treatment for metastatic melanoma is rapidly evolving. In the past, chemotherapy such as dacarbazine was used, but had relatively limited effectiveness. In recent years, several new medications have been approved for melanoma treatment. These include targeted therapies (vemurafenib, dabrafenib, trametanib) and immunotherapies (ipilimumab, pembrolizumab). Other drugs are likely to be approved in the near future.

Clinical trials are often the best option for patients with metastatic melanoma. Investigators at John Wayne Cancer Institute  strive to develop treatment approaches that have the greatest chance of success. Determining the right treatment for any individual requires careful consideration of both the patient’s situation and preferences as well as the opportunities for treatments available as standards or in a clinical trial. Comprehensive consideration of all treatment options in a multidisciplinary context will enable a patient to develop a long-term treatment strategy that will give them the best opportunity for treatment success and optimal quality of life.