Skin cancer is the most common type of cancer and it can take several forms, most of which are not life-threatening and typically do not spread to other parts of the body.
The exception is melanoma, the rarest and most aggressive form of skin cancer. But even melanoma can have a nearly 100 percent cure rate, if it's caught and treated early.
Listen in as Dr. Kim Margolin discusses melanoma and the latest advances in treatment at City of Hope.
Selected Podcast
Melanoma: Do You Know What to Look For?
Featured Speaker:
Dr. Margolin earned her undergraduate degree summa cum laude from University of California, Los Angeles, graduating Phi Beta Kappa, then went on to receive her medical degree from Stanford University School of Medicine. After internal medicine residency at Yale-New Haven Hospital in New Haven, CT, Dr. Margolin began her fellowship in hematology/oncology at the University of California, San Diego School of Medicine and completed the fellowship in medical oncology and hematology and bone marrow transplantation at City of Hope. She remained on the City of Hope faculty in both departments for 25 years prior to her recruitment to Seattle.
Learn more about Kim A. Margolin, MD
Kim Margolin, MD
Kim A. Margolin, MD is a clinical professor in the department of medical oncology & therapeutics research, specializing in melanoma.Dr. Margolin earned her undergraduate degree summa cum laude from University of California, Los Angeles, graduating Phi Beta Kappa, then went on to receive her medical degree from Stanford University School of Medicine. After internal medicine residency at Yale-New Haven Hospital in New Haven, CT, Dr. Margolin began her fellowship in hematology/oncology at the University of California, San Diego School of Medicine and completed the fellowship in medical oncology and hematology and bone marrow transplantation at City of Hope. She remained on the City of Hope faculty in both departments for 25 years prior to her recruitment to Seattle.
Learn more about Kim A. Margolin, MD
Transcription:
Melanoma: Do You Know What to Look For?
Melanie Cole (Host): Skin cancer is the most common type of cancer and it can take several forms, many of which are not life threatening and typically do not spread to other parts of the body. Melanoma, however, is a different situation. My guest today is Dr. Kim Margolin. She’s a clinical professor in the department of medical oncology and therapeutics research specializing in melanoma at City of Hope. Welcome to the show. Dr. Margolin. Tell us about melanoma. How would somebody even know if they have it?
Dr. Kim Margolin (Guest): Melanoma is generally an appearance of dark lesion either in a pre-existing mole or often in a new spot where there wasn’t previously a mole--although there is a system that the dermatologists like to use that’s called the ABCDE system. “A” for asymmetric, “B” for border irregularity, “C” for color variation, “D” for diameter larger than 6 millimeters. They’ve added an “E” for evolution, and most importantly, it’s either the evolution or change in an existing mole or the sudden appearance of a usually dark spot where there was none before. Now there are, of course, many dark spots that are not melanoma but that’s where the dermatologists need to learn how to distinguish the features between melanomas and benign other skin lesions and to biopsy anything that’s suspicious.
Melanie: And, if it’s found to be melanoma, what are some of the treatments available? People think of systemic treatments for all kinds of cancers. What do you do specifically for melanoma?
Dr. Margolin: The first line of defense for melanoma is always surgery. The first thing is to make the diagnosis which, depending on the size and the shape of the lesion and its location on the body, may be biopsied with a shave device that essentially takes off the top part of the lesion. It’s not recommended for lesions that are highly suspected to be melanoma because, indeed, it cuts through tumor, and we try not to do that. But, sometimes, it’s the most practical thing to do. What’s most important is that once the tissue diagnosis is made--the systemic diagnosis--of melanoma is made, it’s critical that the patient has the entire area of skin resected or removed, and that a margin around of what’s known to be active cancer is provided which, basically, takes into account the fact that sometimes isolated cells, cancer cells, can move from the site of the primary into the local skin, and if you can cut a wide area of no melanoma around that, you can give the patient a very reduced chance that it will recur locally. Depending on the depth or how thick the lesion is, and it’s measured in millimeters and fractions of millimeters in thickness, there may be an indication to explore the lymph nodes that are most close to the place where the melanoma was removed. For example, if it’s on the arm, it would be the lymph nodes in the corresponding armpit, and to examine them for evidence of cancer. If they have none, then that’s reassuring to the patient. If they have any cancer in them, then that often means that there’s a higher risk that the tumor may recur in the future. If that is the case, then we try to give medications that may reduce the chance of cancer coming back. Those are generally immunologically oriented interventions that stimulate the body, so white blood cells in some fashion, to recognize and kill any single circulating tumor cells they might encounter. We’re still working on the best form of immunotherapy to prevent melanoma from returning because it’s still quite difficult when it has spread.
Melanie: Is there a genetic component to melanoma?
Dr. Margolin: If you mean is there an inherited risk for melanoma, then--I’m going to assume that’s a yes--that there are families with a risk of melanoma that’s confer because they are born with gene mutations that predispose them to develop melanoma upon the exposure to some secondary routine insult like a second mutation. However, that is quite rare. The incidence of familial transmission for melanoma among all melanomas is only in the range of a couple percent, and the vast majority of melanomas are sporadic in nature.
Melanie: Are you using targeted therapy for melanoma?
Dr. Margolin: We use targeted therapies for certain types of melanoma when they’re advanced, when the melanoma has spread and there’s no longer minimal to cure, and if the patient’s melanoma demonstrates the presence of selected mutations that may lead to the hyperactivation of certain pathways in the melanoma cell. There are drugs for those pathways that block them and cause remissions in patients whose tumors are driven by those mutations. Those mutations occur in about half of patients with garden variety skin melanoma, not so much in the patients whose melanomas arise in the eye or in the mucous membranes or in the fingernails.
Melanie: If somebody is diagnosed with melanoma and you’ve tried some of these treatments, and they do go into remission, are they at risk, then, for melanoma to come back or would it come back as another type of cancer having spread or a metastatic cancer?
Dr. Margolin: A patient who’s in remission from systemic therapy of metastatic disease with immunotherapy will, of course, be at risk of relapse. It’s hard to be sure just what that risk is and how it decreases over time but, in general, we can’t guarantee that somebody stays in remission until we can look back and see that they’ve been in remission for a long time. However, the longer somebody is in remission, the higher chances that they will stay in remission, and the data that we have, most of the drugs we’re using now are so new because of the recent huge breakthroughs in therapy, that we can't really give data yet on how long remissions last, and how many patients might be actually cured. There might be a substantial proportion of patients who achieve remission with immunotherapy who are cured. There’s probably a smaller proportion of patients who achieve a remission with molecularly targeted agents who will be cured. Some people think it’s zero. Some people think it may be 10-20% depending on whose data you look at and how long the follow-up has continued. So, we’re going to have better answers to all of these with longer term follow up with all of the therapies, and then we’re going to have new therapies as well.
Melanie: And, are you doing any clinical trials for melanoma at City of Hope?
Dr. Margolin: I try to put all my patients on clinical trials as much as possible. We have clinical trials here for virtually every stage and category of melanoma with very rare exceptions, perhaps not so much for melanoma arising from the eye because that’s so rare, but for all of the other subsets. There are new clinical trials coming all the time. I’m very involved in helping to write some of those trials; I’m leading some of those trials; and, others come from a variety of groups I participate with.
Melanie: Dr. Margolin, wrap it up for us, and give your best advice and hope to those that may have been diagnosed with melanoma, and why they should come to City of Hope for their care.
Dr. Margolin: The City of Hope really specializes in providing clinical trials for patients with cancer and for those who don’t fit into a clinical trial, the best cutting edge care that we can possibly deliver. Clinical trial participation will always be, at the very worst, the best thing we can give, and at the best will be something even better. Whether you participate in a clinical trial or you do not, you’ll get the best care here. There’s very little that we cannot do here. We have access to all of the sophisticated methodologies, both medical, surgical and radiation, and we use them in all patients who need them.
Melanie: Thank you so much for being with us today, Dr. Margolin. You're listening to City of Hope Radio, and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Melanoma: Do You Know What to Look For?
Melanie Cole (Host): Skin cancer is the most common type of cancer and it can take several forms, many of which are not life threatening and typically do not spread to other parts of the body. Melanoma, however, is a different situation. My guest today is Dr. Kim Margolin. She’s a clinical professor in the department of medical oncology and therapeutics research specializing in melanoma at City of Hope. Welcome to the show. Dr. Margolin. Tell us about melanoma. How would somebody even know if they have it?
Dr. Kim Margolin (Guest): Melanoma is generally an appearance of dark lesion either in a pre-existing mole or often in a new spot where there wasn’t previously a mole--although there is a system that the dermatologists like to use that’s called the ABCDE system. “A” for asymmetric, “B” for border irregularity, “C” for color variation, “D” for diameter larger than 6 millimeters. They’ve added an “E” for evolution, and most importantly, it’s either the evolution or change in an existing mole or the sudden appearance of a usually dark spot where there was none before. Now there are, of course, many dark spots that are not melanoma but that’s where the dermatologists need to learn how to distinguish the features between melanomas and benign other skin lesions and to biopsy anything that’s suspicious.
Melanie: And, if it’s found to be melanoma, what are some of the treatments available? People think of systemic treatments for all kinds of cancers. What do you do specifically for melanoma?
Dr. Margolin: The first line of defense for melanoma is always surgery. The first thing is to make the diagnosis which, depending on the size and the shape of the lesion and its location on the body, may be biopsied with a shave device that essentially takes off the top part of the lesion. It’s not recommended for lesions that are highly suspected to be melanoma because, indeed, it cuts through tumor, and we try not to do that. But, sometimes, it’s the most practical thing to do. What’s most important is that once the tissue diagnosis is made--the systemic diagnosis--of melanoma is made, it’s critical that the patient has the entire area of skin resected or removed, and that a margin around of what’s known to be active cancer is provided which, basically, takes into account the fact that sometimes isolated cells, cancer cells, can move from the site of the primary into the local skin, and if you can cut a wide area of no melanoma around that, you can give the patient a very reduced chance that it will recur locally. Depending on the depth or how thick the lesion is, and it’s measured in millimeters and fractions of millimeters in thickness, there may be an indication to explore the lymph nodes that are most close to the place where the melanoma was removed. For example, if it’s on the arm, it would be the lymph nodes in the corresponding armpit, and to examine them for evidence of cancer. If they have none, then that’s reassuring to the patient. If they have any cancer in them, then that often means that there’s a higher risk that the tumor may recur in the future. If that is the case, then we try to give medications that may reduce the chance of cancer coming back. Those are generally immunologically oriented interventions that stimulate the body, so white blood cells in some fashion, to recognize and kill any single circulating tumor cells they might encounter. We’re still working on the best form of immunotherapy to prevent melanoma from returning because it’s still quite difficult when it has spread.
Melanie: Is there a genetic component to melanoma?
Dr. Margolin: If you mean is there an inherited risk for melanoma, then--I’m going to assume that’s a yes--that there are families with a risk of melanoma that’s confer because they are born with gene mutations that predispose them to develop melanoma upon the exposure to some secondary routine insult like a second mutation. However, that is quite rare. The incidence of familial transmission for melanoma among all melanomas is only in the range of a couple percent, and the vast majority of melanomas are sporadic in nature.
Melanie: Are you using targeted therapy for melanoma?
Dr. Margolin: We use targeted therapies for certain types of melanoma when they’re advanced, when the melanoma has spread and there’s no longer minimal to cure, and if the patient’s melanoma demonstrates the presence of selected mutations that may lead to the hyperactivation of certain pathways in the melanoma cell. There are drugs for those pathways that block them and cause remissions in patients whose tumors are driven by those mutations. Those mutations occur in about half of patients with garden variety skin melanoma, not so much in the patients whose melanomas arise in the eye or in the mucous membranes or in the fingernails.
Melanie: If somebody is diagnosed with melanoma and you’ve tried some of these treatments, and they do go into remission, are they at risk, then, for melanoma to come back or would it come back as another type of cancer having spread or a metastatic cancer?
Dr. Margolin: A patient who’s in remission from systemic therapy of metastatic disease with immunotherapy will, of course, be at risk of relapse. It’s hard to be sure just what that risk is and how it decreases over time but, in general, we can’t guarantee that somebody stays in remission until we can look back and see that they’ve been in remission for a long time. However, the longer somebody is in remission, the higher chances that they will stay in remission, and the data that we have, most of the drugs we’re using now are so new because of the recent huge breakthroughs in therapy, that we can't really give data yet on how long remissions last, and how many patients might be actually cured. There might be a substantial proportion of patients who achieve remission with immunotherapy who are cured. There’s probably a smaller proportion of patients who achieve a remission with molecularly targeted agents who will be cured. Some people think it’s zero. Some people think it may be 10-20% depending on whose data you look at and how long the follow-up has continued. So, we’re going to have better answers to all of these with longer term follow up with all of the therapies, and then we’re going to have new therapies as well.
Melanie: And, are you doing any clinical trials for melanoma at City of Hope?
Dr. Margolin: I try to put all my patients on clinical trials as much as possible. We have clinical trials here for virtually every stage and category of melanoma with very rare exceptions, perhaps not so much for melanoma arising from the eye because that’s so rare, but for all of the other subsets. There are new clinical trials coming all the time. I’m very involved in helping to write some of those trials; I’m leading some of those trials; and, others come from a variety of groups I participate with.
Melanie: Dr. Margolin, wrap it up for us, and give your best advice and hope to those that may have been diagnosed with melanoma, and why they should come to City of Hope for their care.
Dr. Margolin: The City of Hope really specializes in providing clinical trials for patients with cancer and for those who don’t fit into a clinical trial, the best cutting edge care that we can possibly deliver. Clinical trial participation will always be, at the very worst, the best thing we can give, and at the best will be something even better. Whether you participate in a clinical trial or you do not, you’ll get the best care here. There’s very little that we cannot do here. We have access to all of the sophisticated methodologies, both medical, surgical and radiation, and we use them in all patients who need them.
Melanie: Thank you so much for being with us today, Dr. Margolin. You're listening to City of Hope Radio, and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.