Melenanoma/Advanced Skin Cancer Program

INCIDENCE AND PREVALENCE

With an estimated 91,270 individuals diagnosed in the United States in 2018, melanoma accounts for 5.3% of all new cancer cases.1 The incidence of melanoma in Southern California is among the highest in the world.

PROGRAM OVERVIEW

Hoag Family Cancer Institute’s Melanoma/Advanced Skin Cancer Program, in alliance with USC Norris Comprehensive Cancer Center, offers a multidisciplinary approach to the diagnosis and treatment of melanoma. The team, consisting of specialists in oncologic surgery, medical oncology, radiation oncology, dermatology, high risk dermatology, plastic and reconstructive surgery, pathology, and medical genetics, is led by by USC surgeon Burton Eisenberg, M.D., executive medical director of Hoag Family Cancer Institute and Grace E. Hoag Executive Medical Director Endowed Chair. It has the expertise and experience to treat the most complex primary and metastatic cases.

Binh Ngo, M.D., Hoag high risk dermatologist and clinical associate professor of Dermatology at USC, partners with community dermatologists to work with high risk patients for early detection and evaluation of recurrences. She has a major interest in familial melanoma and the genetic pathways of its transmission. Hoag Family Cancer Institute has a strong medical genetics service, and complete family histories and pedigrees are obtained. The team recommends that family members of high risk patients are also seen to assess their risk.

DIAGNOSTICS

In melanoma diagnostics, it is sometimes difficult to differentiate benign skin moles that can mimic malignant melanoma. Dr. Ngo has a research project with several USC dermatologists who have expertise in the techniques to identify true melanomas in this clinical circumstance. These biopsies are subject to new technology employing gene expression array profiling in collaboration with Myriad Laboratories to assist in the important diagnostic problem. If malignant melanoma is diagnosed, it is necessary to evaluate the possibility that it has spread. Sentinel lymph node biopsies performed by Dr. Eisenberg are critical to make this determination. PET/CT scanners are utilized to assess for distant metastatic disease and for recurrence of cancer.

Patients also have access to comprehensive tumor profiling through Hoag Family Cancer Institute’s partnership with Caris Life Sciences, which may identify actionable gene mutations that should be considered in the development of the patient’s treatment plan.

For individuals who are not currently under the consistent care of a dermatologist, Hoag Family Cancer Institute offers free skin screenings in partnership with community dermatologists. As part of the Melanoma/Advanced Skin Cancer Program, patients at increased risk can be screened by referral from their dermatologist with the use of FotoFinder®, a digital high-resolution skin mapping system, under the guidance of Dr. Ngo.

TREATMENT

Tumor Board

The multidisciplinary Melanoma/Cutaneous Tumor Board is attended by oncologic surgeons, plastic and reconstructive surgeons, medical oncologists, radiation oncologists, pathologists, medical geneticists, genetic counselors, support staff, and the nurse navigator. The Melanoma/Cutaneous Tumor Board meets the second and fourth Friday of every month at 7:30 a.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by Burton Eisenberg, M.D., Grace E. Hoag Executive Medical Director Endowed Chair. To submit a case for the Melanoma Tumor Board, contact the Melanoma Nurse Navigator, Rhonda Hjelm, M.S.N., R.N., O.C.N., at 949-764-1945 or [email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

Surgery

Hoag and USC’s oncologic surgeons subspecialize in melanoma and advanced skin malignancies and maintain a high volume of melanoma surgeries, including sentinel lymph node biopsies. A key benefit to patients is the program’s alignment with plastic and reconstructive surgeons, which allows the surgical team to perform major melanoma surgeries and immediate primary reconstruction.

Medical Oncology

The medical oncologists affiliated with Hoag’s Melanoma/ Advanced Skin Cancer Program have a special focus on melanoma patients, allowing them to have a deep understanding of the unique aspects of the disease as well as the latest therapeutics. They also prescribe immunotherapy and other adjuvant treatments to prevent disease recurrence in patients where projected recurrence risk is high.

In the past several years, new immunotherapy called checkpoint inhibitors have emerged to successfully treat metastatic melanoma. These drugs and other targeted agents are used routinely by the medical oncologists to manage patients with advanced melanoma.

Radiation Oncology

Hoag’s Radiation Oncology department provides superficial radiation therapy for basal and squamous cell cancers. Superficial radiation therapy is a low energy radiation therapy modality specially designed to treat non-melanoma skin lesions while protecting the underlining normal tissues.

CLINICAL RESEARCH

At least eight new drugs have been approved by the FDA for the treatment of melanoma since 2011 and additional promising drugs are in the pipeline. Through Hoag’s Developmental Therapeutics Program in alliance with USC Norris Comprehensive Cancer Center, melanoma patients with advanced disease can be treated with novel drugs through early phase clinical trials before they are widely available. The following clinical trials have opened for patients with melanoma. For a list of trials currently open, please contact Leila Andres, M.S., at 888-862-5318.


(151-17) 0C-14-11: A Phase 1, Open-Label, Dose Escalation Study of Pf-04518600 as a Single Agent in Combination with PF-05082566 in Patients with Selected Locally Advanced or Metastatic Carcinomas (Phase 1 clinical trial, appropriate for patients with locally advanced or metastatic carcinomas of the skin.)


(104-17) DecisionDx-Melanoma 31-Gene Expression Profile Clinical Impact Study #4. PI: Binh Ngo, M.D.


(151-17) 0C-14-11: A Phase 1, Open-Label, Dose Escalation Study of Pf-04518600 as a Single Agent and In Combination with PF-05082566 in Patients with Selected Locally Advanced or Metastatic Carcinomas


(131-17) 0C-16-8: A Phase 1/2 Safety Study of Intratumorally Administered INT230-6 in Adult Subjects with Advanced Refractory Cancers (Phase 1 clinical trial appropriate for patients with solid tumors)

SCREENING AND HIGH RISK SERVICES

With early detection and surgical management, the cure rate for melanoma can approach 95%. The Melanoma and Advanced Skin Cancer Program encourages regular skin screening with a dermatologist. For individuals who may not be under the active care of a dermatologist, Hoag Family Cancer Institute partners with community dermatologists to host free skin cancer screenings annually. Two screenings were held in 2017.

The Program’s High Risk Melanoma Service provides focused care and ongoing surveillance for individuals with a past history of several melanomas or for those patients who meet other risk factor criteria including mole pattern, strong family history or a germline mutation. Patients can access the services with a referral from their dermatologist.

Hoag is one of the few sites in California with a FotoFinder® system, a computer enhanced skin imaging system that scans the entire skin surface. Its highresolution images detect changes that are often invisible to the naked eye. Some high risk patients are referred to annual or more frequent skin mapping with the use of FotoFinder® while other patients may be referred to genetic testing or to the program’s medical geneticist for further evaluation and recommendations.

The Castle Bioscience Genetic Array technology is used for current high risk melanoma patients to more accurately predict risk of recurrence and potential for metastatic disease. The test provides a recurrent score based on a panel of 31 genes variable expression ratios.

High risk screening tool, FotoFinder®, is a diagnostic advantage
for Hoag's Melanoma/Advanced Skin Cancer Program.

SUPPORT AND EDUCATION

Every patient who receives care through Hoag’s Melanoma and Advanced Skin Cancer Program has access to the specialized Nurse Navigator, Rhonda Hjelm, M.S.N., R.N., O.C.N. In addition to navigating patients through their treatment and the health care system, she provides guidance and emotional support and communicates frequently with the multidisciplinary team ensuring patientcentered and coordinated care throughout diagnosis, treatment and survivorship.

Rhonda leads the program’s community outreach efforts, imparting the importance of early detection at health fairs and other community settings.

Genetic counseling and testing through Hoag’s Hereditary Cancer Program is available for patients who have a family history of melanoma or other cancers that may increase their risk.

Patients also have access to a variety of education classes, workshops, and support services through Hoag Family Cancer Institute’s Integrated Cancer Support Services.

1 Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, https://seer.cancer.gov/statfacts/html/melan.html

For more information call: 949-722-6237