Hello and thank you for submitting your question,

Your question is a very good one and I will work on providing you with some good information and recommendations’ regarding what is going on.

Regarding melanoma cancer itself can sometimes invade very XXXXXXX into the skin. I think it is important for you to have a complete assessment of the depth of invasion. I am sure your doctor will have this assessed when the melanoma is removed. A melanoma can be very superficial but can sometimes invade XXXXXXX into the skin. On the scalp it can possibly invade all the way through to the bone of the skull.

I suspect that you have had the melanoma removed or is that there is a plan to have the melanoma removed by a surgeon. After the surgical procedure the tissue will be submitted to a pathologist for a very thorough review. Pending the results of the pathologist review your doctor and your oncologist will decide on the next appropriate step in management of the melanoma. Many patients simply have a surgery followed by a follow up plan which will include examinations as well as laboratory studies and sometimes imaging studies as well.

At the same time it is extremely important that you have a complete skin examination on a regular basis for the rest of your life. This can be performed by your oncologist or your dermatologist. There have been many amazing advances in the treatment of melanoma in the last several years. This is more of a limited stage melanoma that you are dealing with in my opinion. At the same time if you have the ability to send me a copy of the biopsy report as well as the surgical report from your physician and your surgeon I can make better recommendations and conclusions regarding your case.

I thank you again for submitting your question. I hope you found my responses to be helpful and informative. If you have the ability to send me some scans of those reports which I requested you may do so by e-mailing them to my attention at YYYY@YYYY . I will then get back to you as soon as possible with further discussion.

Sincerely,

Dr. Robert

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Hello again and thanks for the follow-up.

There are several treatment options. First of all - your physician should test the tumor for a specific mutation called BRAF. There is now a targeted therapy for tumors with this therapy which seems to work quite well. Again this is only in the case of advanced melanoma. If yours is localized additional treatment would involve surveillance only.

Other options for advanced melanoma include chemotherapy or immunotherapy. Among immunotherapy drugs like interleukin-2 is used very frequently. It is a difficult therapy with many side effects but can work well for 15 percent of patients.

Also there is a new drug called Yervoy which again works through the immune system to stimulate destruction of cancer cells in melanoma. This would be another consideration in advanced stage melanoma.

I think it is premature to worry about advanced stage disease right now. Focus more on the surgery to be done. Your doctor may also request CT (Computerized Tomography) or MRI (Magnetic Resonant Imaging) of the brain as well as CT scans of the chest to evaluate and make sure the rest of your body is clear of any disease. They may also request a PET (Positron Emission Testing) scan which done along with a CT can help doctors find tiny areas of cancer that previously would not have been found.

Take this one step at a time with a positive attitude and good support of friends and family.

Thanks again for the query. I hope this is serving to be informative to you. Please let me know if you have additional concerns.

Sincerely,

Dr. Galamaga

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Hello and thanks for the followup.

Again I appreciate your concern. A major characteristic as well is presence or absence of ulceration in the biopsy or excision specimen. This is something the pathologist will look at. Sometimes as well a surgeon may perform a lymph node biopsy in the lymph node region closest to where the melanoma was found. This may provide some help in further staging the melanoma.

With this thickness this is likely a stage II melanoma. You need to be properly staged however with systemic imaging including PET scan.

If you are able to provide the pathology reports from the biopsy and excision I would be happy to advise what might be recommended as far as followup and or treatment. Certainly a PET scan should be considered.

If you are able to gather more of the information after your excision I would be happy to comment on them. These can be sent to my attention at YYYY@YYYY .

One step at a time. It is most important now to focus on having the excision done followed by healing and further discussion.

Thanks again for the query. I hope you have found this to be a healthy exchange of information. If you have additional concerns I would be happy to discuss them with you.

Sincerely,

Dr. Galamaga

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