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