Mayo Clinic's melanoma program uses the latest science and care practices in treatment of patients with melanoma including precise diagnosis, skilled surgical excision and the latest immunotherapies. Physician-scientists collaborate on patient care, innovative research and diagnostic excellence to provide highly individualized melanoma care.
In this video, Alexander Meves, M.D., a dermatologist for Mayo Clinic in Minnesota, Tina J. Hieken, M.D., a surgical oncologist for Mayo Clinic in Minnestoa, and Svetomir N. Markovic, M.D., Ph.D., a medical oncologist for Mayo Clinic in Minnesota discuss advances in melanoma care.
Hello. My name is Tamara Bush. A physician liaison at Mayo clinic. Thank you for viewing our discussion on the topic of melanoma treatment at Mayo clinic, identifying the melanoma stage, depth and severity is critical for selecting the most appropriate treatment combination. Mayo clinic doctors have access to the latest and diagnostic methods and treatment innovations to improve care for patients with melanoma. Understanding the complexities of melanoma is achievable through an openly collaborative effort by dedicated experts. I am joined by my colleagues. Dr alexander Mavis, a dermatologist, Dr Tina hike in a surgical oncologist and dr speed over Markovic, a medical oncologist who have an integrated clinical practice for patients that have been diagnosed with melanoma. Let's begin our conversation Dr Mavis premier perspective as a dermatologist. Would you discuss the melanoma diagnostic methods for patients offered at Mayo clinic within your practice? In addition when you talk about your research of genomic profiling of melanoma being done at Mayo clinic. Yes. Thank you Tammy. Um I wanted to start out by saying that at Mayo Clinic we really try very hard to tailor melanoma treatments to each individual patient. And so one key question that we need to address immediately a diagnosis, how dangerous do we think this cancer is, what is the likelihood of this smell, a normal metastasizing and creating widespread disease and how aggressive do we need to be with treatment. So in dermatology we diagnosed a lot of an enormous every year but we know that not all of these melanomas are actually dangerous. In fact like most of these melanomas were diagnosed. They will never lead to problems and I just cured by local excision. And so the question is how do we find the ones that need our attention? Perhaps need a referral to Dr Heiken for London North surgery or you know, even treatment with powerful new immunotherapy drugs that are administered by Dr Markovic. And the answer to that is that we mostly rely on a very simple concept, the idea of tumor invasion depth. So in other words, the deeper melanoma has grown into the skin, the higher the risk of having a bad outcome, since we call the measurement of this invasion depth breast breast cell thickness. And if brussels signals is beyond a certain threshold we worry about a bad outcome. So the concept of brussel sickness was actually developed in the late 1960s and you know, we've come a long way since and refining our understanding of cancer at the molecular level and we now have the technology to measure molecular changes in too much issue. And just routinely collected biopsy tissue. And so it made a clinic, we developed a test called the Merlin essay that quantifies molecular changes and too much issue and can be used to better differentiate between low and high risk melanoma than brussels thickness alone. And so in other words, if you have a melanoma that we would call higher risk by the traditional russell thickness approach. The Maryland essay may reclassify this lesion as low risk because it not only takes into account wrestle thickness but also molecular data that was previously unattainable. And so this ability to better as we call it risk, stratify melanoma, fire burning in Berlin testing can help patients avoid unnecessary procedures such as sentinel, infinite biopsies. But for a test like the Merlin essay to be widely accepted by the medical community, it needs to be validated extensively in in thousands of patients just like back in the 60s and 70 Dr brussel had divided his message and so we have therefore initiated this extensive validation program which is headed by dr hiking. Thank you Dr Mavis dr Hankin as a surgical oncologist. Clinical trials work in tandem with your surgical practice. How do patients with early and advanced stage melanoma benefit from the combination of these innovative treatments? Thanks so much tammy um it's great to join my colleagues here and have an opportunity to talk a little bit about our practice. So for our practice we see patients with early stage disease to late stage disease. And really the secret to our ability to care for these melanoma patients is our team based approach. So some are practitioners who the patients will meet and these are dermatologist, radiation oncologists. Medical oncologists and surgical oncologists like myself and then some who work more behind the scenes, such as some of our expert radiology colleagues and pathology colleagues who really help us provide the best possible care to patients. So our own group includes a specialty trained melanoma surgical oncologists and we have come up with a number of innovations along with our colleagues to try and minimize the side effects of treatment so that when it's required we can do things in a minimally invasive way with some innovative techniques to really minimize long term effects. Most importantly, here, we really have this combination of great facilities and an expert um medical staff that allows us to provide the most accurate and precise uh test results, not just performing testing and doing treatment but doing both in a really exemplary fashion. And some things that appear to be simple are actually more complex than they appear and really depend on us. Working hand in hand with our colleagues in terms of clinical trials are the things that the trial, the doctor Mavis mentioned the Merlin. No one trial is one that we were fortunate to help initiate and along with seven other us melanoma centers to validate this approach to looking at a combination of clinical and genomic factors to figure out which of our patients with intermediate thickness melanoma, who have no clinical evidence of spread of the melanoma to the lymph nodes really might benefit from surgical staging their disease, in which patients really don't need it and might avoid it. Patients who are having melanoma sentinel lymph node surgery here at mayo Rochester or nail florida or mayo Arizona all eligible to participate in the study and some of the things that we'll be looking at along with the validation component are some scientific correlative and some patient reported outcomes work kind of at the other end of the spectrum of our practice for patients who have the opposite of that clinically evident disease that's already gone to the lymph nodes. Were working with other medical oncology colleagues um and a study that's open at University of Minnesota and mayo florida and male Rochester called neo activated. In this study, we're really looking at these novel combinations of immunotherapy based on the hypothesis that so immunotherapy given for a short period of time before surgery may actually be more effective in developing a very precise tumor specific response for the patient and improving patient outcomes compared to doing a potentially curative operation first and then giving a year of treatment afterwards. It also gives us an opportunity to shorten the treatment time for patients and to do some scientific research along with this. So one of the things that we're looking at is technical and that's looking at whether or not the lymph node that's originally biopsy to establish the diagnosis might be a great barometer of the disease status of that whole area of lymph nodes and therefore might be used in the future to help us further deescalate surgical treatment. And secondly, we're doing a lot of blood and tissue and microbiome based essays to help us try and sort out, why do some patients have a great response to treatment while other patients who seem to be quite similar. Don't why do some patients have significant toxicities of some of these treatments that are lifesaving while others have very very minor effects or none. And you know what's going on here so that we might uh develop really precise therapies and minimize the toxicity of these treatments. So what's really exemplary and really great for someone like me working here is to work with such intelligent and committed colleagues, both clinicians and scientists and sometimes who wear both hats. Really committed to rapid advancement and sort of state of the science work and then bringing that right back to the bedside because we're really all aligned in just trying to improve care for individual melanoma patients. So thanks for the opportunity to speak today. Thank you dr hike in Dr Markovic as a medical oncologist. Would you work closely with melanoma research program at Mayo Clinic? Would you talk about the program and how this research translates into clinical care for the patient? Thank you tammy for the opportunity to speak with me today and for sharing this beautiful menu with us to discuss the whole practice. I've had the pleasure of being associated with Melanoma program since it's in section 22 years ago and I'm truly proud and privileged to work with such brilliant colleagues of dr yeah, over the years, what we've tried to do is to provide the best care of our patients using what has historically been the Mayor model of care. We all work together. We all share our experiences. We build on our experiences to create the best possible treatment options that we can come up with for every patient. Yeah. We also applied the same collaborative effort with colleagues that do research. Not only take care of patients, many of us are trained both as scientists and physicians. And the application of that scientific knowledge into the care of patients every day is something that we truly find gratifying and the aim of our very There are many examples of this that I would just simply like to share with you. A few that had come to mind. For instance, Dr Jeff johnson and our compassion plot worked together at the johnson is a nuclear medicine expert. Someone who works behind the scenes in our practice, we developed peptide that will directly by tomorrow says to make a better scanner, it's destructive words identified cancer cells better we can add to it therapeutic radioactive substances that will then treat them all. Mark Dr Lauren Devlin studies it's an ophthalmologist. She studies melanoma of the eye. That's robert Mcwilliams of your friend of mine studies melanoma of the mucosal mucosal origins which is uniquely difficult to treat and is currently preparing a large national study. All right, James Jacob, our surgical oncology, colleague studies in Transit normal metastases when the melanoma jumps from one lymph channel to the other spreading throughout the skin. He has devised a method with collaborators across the country to use a device through which he can deliver therapy treat the and finally, my dear friend Dr Tobias Spiker, who is a pulmonologist, someone that we don't normally see in our practice, who is devising a method to deliver immune therapy by population, not just in the vein, to try to reset the immune systems, going to recognize the kids. There are many other examples but the interest attack. All I would say is that I've felt privileged and honored for the last 22 years to work with such an amazing one thing is for sure, can't work in order to make our patients better with this horrible business. Read scripts. So I'll think thank you Dr Markovic. We would like to conclude by saying thank you for reviewing our discussion about the integrative practice for the treatment of melanoma at Mayo Clinic