Melanoma

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Research in melanoma skin cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat melanoma skin cancer. They are also looking for ways to improve the quality of life of people with melanoma skin cancer.

The following is a selection of research showing promise for melanoma skin cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage melanoma skin cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Computer imaging programs may be able to accurately and reliably identify abnormal areas of the skin, including melanoma. Researchers hope that these imaging programs will help doctors diagnose melanoma skin cancer and other skin problems (Telemedicine Journal and e-Health, PMID 26218353).

Teledermatology sends digital skin images through email or the web for a doctor to look at. It may be useful as a first step in diagnosing skin cancer for people who don’t have access to a dermatologist because they live in a remote area or for other reasons. (Journal of Telemedicine and Telecare, PMID 28056600; Journal of the American Academy of Dermatology, PMID 25599624).

Reflectance confocal microscopy (RCM) is an imaging technique that uses a special microscope and beams of laser light to look at the layers of the skin. Studies show that RCM seems to be an accurate diagnostic tool for skin cancer, including melanoma skin cancer (Journal of the European Academy of Dermatology and Venereology, PMID 27230832).

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. Researchers are looking at biomarkers, such as microRNA (short pieces of RNA that control cell growth and death) and circulating tumour DNA (DNA from tumour cells in the blood), to see if they can help doctors predict a prognosis and response to treatment in people with melanoma skin cancer (Genes, Chromosomes and Cancer, PMID 27561079; Clinical Cancer Research, PMID 27482033; Advances in Clinical Chemistry, PMID 25934359). For example, a study found that circulating tumour DNA could be used to measure how well melanoma responds to targeted therapy and monitor if the therapy is still working (Oncotarget, PMID 26524482).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for melanoma skin cancer. Advances in cancer treatment and ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer.

Surgery

The following is noteworthy research into surgery for melanoma skin cancer.

Surgical margin is the area of healthy tissue removed along with the tumour. A study compared wide surgical margins (3 cm of tissue removed around a melanoma skin cancer) to narrow surgical margins (1 cm of tissue removed around a melanoma skin cancer). Results show that wide surgical margins lowered the risk that melanoma would come back (recur) in the same area and improved survival (ASCO, Abstract 9001).

Complete lymph node dissection removes all the lymph nodes in a certain area. It may be done for certain cases of melanoma skin cancer when a sentinel lymph node biopsy (SLNB) shows there are cancer cells in the first lymph node in a chain or group of lymph nodes that cancer is most likely to spread to (called a positive SLNB). Researchers want to find out if doing a complete lymph node dissection after finding a positive SLNB improves survival compared to observation only (CanadianCancerTrials.ca, NCT00389571). Some research shows that there is no difference in survival between a complete lymph node dissection and observation (Lancet Oncology, PMID 27161539).

Find out more about research in cancer surgery.

Immunotherapy

Immunotherapy uses the immune system to help destroy cancer cells. Research is looking at new ways to use immunotherapy as a treatment for melanoma skin cancer, including the following.

Vaccines can be used to help your immune system fight cancer cells. Researchers are studying vaccines to find out if they can prevent melanoma skin cancer from coming back after surgery (CanadianCancerTrials.ca, NCT01546571; Journal of Clinical Oncology, PMID 26351350).

Talimogene laherparepvec (T-VEC, Imlygic) is an oncolytic viral therapy that is injected directly into the melanoma. Oncolytic viruses can infect and destroy cancer cells without harming normal cells. T-VEC uses a genetically modified herpes simplex virus that stimulates melanoma cells to make granulocyte-macrophage colony-stimulating factor (GM-CSF). This helps the body recognize and work against the melanoma cells. Clinical trials show that T-VEC improved overall survival and increased the time that the cancer responds to treatment (called the duration of response). T-VEC was especially effective in people who had never been treated for metastatic melanoma or who had stage 3B, 3C or 4 melanoma skin cancer that had only spread to other areas of the skin or to lymph nodes (Annals of Surgical Oncology, PMID 27342831; Journal of Clinical Oncology, PMID 26014293). In the United States, T-VEC is approved to treat melanoma skin cancer that can’t be removed with surgery (unresectable cancer) or recurrent melanoma skin cancer.

Nivolumab (Opdivo) is an immune checkpoint inhibitor that works by blocking specific proteins (called checkpoint proteins) so immune system cells can attack and kill the cancer cells. Some research shows that people had a better response with nivolumab than chemotherapy if the cancer progressed after treatment with ipilimumab (Yervoy), another immune checkpoint inhibitor (Lancet Oncology, PMID 25795410). Other research found that nivolumab improved survival better than chemotherapy in people with metastatic melanoma skin cancer who hadn’t received any other treatments (New England Journal of Medicine, PMID 25399552).

Find out more about research in immunotherapy.

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Combining different drugs is one of the most promising ways to treat melanoma skin cancer in the future. The following is noteworthy research into targeted therapy for melanoma skin cancer.

Vemurafenib (Zelboraf) combined with cobimetinib (Cotellic) may be an effective treatment for melanoma skin cancer. Clinical trials compared this combination to drugs to vemurafenib alone. They show that the combination of these drugs improves survival in people with melanoma skin cancer with BRAF gene mutations who haven’t received any other treatments (Lancet Oncology, PMID 27480103). Another small clinical trial is studying this combination as a neoadjuvant therapy for melanoma skin cancer with BRAF mutations that has spread to lymph nodes (CanadianCancerTrials.ca, NCT02036086).

Dabrafenib (Tafinlar) combined with trametinib (Mekinist) seems to improve overall survival compared to dabrafenib alone in people with untreated stage 3C or stage 4 melanoma skin cancer with BRAF mutations (Lancet, PMID 26037941; ASCO, Abstract 102). Researchers also found that the combination of dabrafenib and trametinib did not cause more side effects than vemurafenib alone (New England Journal of Medicine, PMID 25399551).

Find out more about research in targeted therapy.

Learn more about cancer research

Researchers continue to try to find out more about melanoma skin cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage melanoma skin cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for melanoma skin cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

granulocyte-macrophage colony-stimulating factor (GM-CSF)

A substance that stimulates the bone marrow to develop white blood cells (especially granulocytes and macrophages). These white blood cells help defend the body against bacteria, viruses and types of fungus.

GM-CSF is a cytokine found naturally in the body. It can also be made in a lab.

GM-CSF is a type of biological therapy used in cancer treatment to stimulate the immune system. It may also be given after chemotherapy to help increase white blood cell counts and to lower the risk of infection.

gene mutation

A permanent change or alteration in a gene.

Gene mutations can be inherited or can be acquired during a person’s life.

neoadjuvant therapy

Treatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery.

Neoadjuvant therapy may be given if a tumour is too large to be removed by surgery. It may include chemotherapy, radiation therapy or hormone therapy.

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