All patients with melanoma receive surgery as part of their treatment plans, and they may need other therapies as well. At Mayo Clinic, surgical oncologists work within multidisciplinary care teams to develop coordinated care plans tailored to the needs of each patient.
Mayo Clinic surgical experts are at the forefront of melanoma treatment and ensure that all patients receive the right amount of surgery for their diagnoses. They explain that the right care plan starts with expert pathology. Care plans can include preoperative systemic or intralesional treatment and advanced procedures such as sentinel lymph node surgery.
Our mission here is to help the patient and the needs of the patient come first. And that means helping out providers, whatever they need to help take care of patients, whether they're local or they live far away. So if it's surgery or just an opinion or medical oncology or intralesional injections, we're here to offer that service here. We recognize that the same tumor or what appears to be the same tumor in two different patients behaves in an entirely different fashion. So that really requires the Melanoma team to tailor treatment to the individual patient and not focused on a diagnosis. Developing a treatment plan from a multidisciplinary perspective with surgery, medical oncology, radiation oncology and dermatology. From the very first visit adds a lot means that the treatment plan is coordinated. There's no going back and forth for visits. There's no contradictions in the plan. You come in, you get the expert diagnosis and you come away with a plan. We have specialized pathologists here who have an interest and expertise in looking at pigmented lesions which can be really, really complicated to look at under the microscope. As many as 10 or 15% of cases that may be classified initially as a melanoma may be reclassified as not even being a melanoma and vice versa. When we meet patients, they often get seen our dermatology practice first and they get a full skin exam, we look at everything from head to toe, make sure we're not missing anything. We always review or re review the pathology to make sure we have the true diagnosis. When we diagnose a primary melanoma, that initial pathology is what really determines the first steps in treatment. All Melanoma patients get some level of surgery. We recommend a procedure, we call a white local excision, which means we cut around the biopsy side. But we go a little deeper than usual, we take out all the fat tissue, we go down to the so called of the muscle. So we go deeper. Then the question is, do we need to do more than that? Do we need to take out lymphatic tissue? For example, for patients with early stage melanoma, we often offer sentinel lymph node surgery. It involves mapping with the tracer for the site of the primary melanoma to identify which lymph node or lymph node groups would be most likely affected by melanoma that we can't yet detect by physical exam. There's a tendency towards doing less surgery and more drug treatment, but we still need both. It's very clear that we still need both. And so we really try to tailor the right amount of surgery to each patient. Our Melanoma Surgical Oncology Group has great expertise in doing these procedures using techniques that are known to decrease the rates of both short and long term complications. Things are in flux a little bit. People who presented with metastasis and their lymph nodes, they would get the surgery first and then drugs. Now we're flipping around the order of how we do therapy. So now some patients get systemic medications First. Intralesional therapy is when we see a metastatic lesion in the skin or in a lymph node, we can inject it directly most often with an on virus, a virus that's been genetically modified to help attack melanoma and recruit the body's immune system to attack melanoma. So by directly injecting a lesion, we're limiting the systemic toxicities and side effects and we really want what's best for patients and we're interested in the next generation of treatments here. We have many investigator initiated clinical trials as well as access to national clinical trials. Not everybody fits the guidelines or fits the textbook answer. So whatever we can do to provide our services here and coordinate that with care back home and come up with the best possible plan for the patient and the patient's well being.
