Author: Julie Scott, DNP

Julie is an oncology certified Oncology Nurse Practitioner with over a decade of medical oncology experience. In addition to her clinical work, she is an accomplished healthcare writer providing oncology content for various publications. She also serves as an adjunct faculty member for a Master's nursing program and a chair for Doctoral nursing students.

The advances in melanoma staging and treatment

Posted on by Julie Scott, DNP

Melanoma Staging

Once a diagnosis of melanoma has been made, the oncologist may order imaging studies to see if melanoma has spread to other areas of the body. Melanoma is staged from stage 0 to IV, with melanoma becoming more advanced the higher the stage. 

When the biopsy has resulted with melanoma, and staging studies have been completed, the oncologist can develop a treatment plan. 

Melanoma Treatment

Surgery is often used as a treatment for melanoma, with the type of surgery being a wide local excision (WLE). During this type of surgery, the entire melanoma lesion along with a wide amount of healthy tissue surrounding it is taken out, to be sure the entire melanoma has been removed. The full amount of tissue that needs to be removed depends upon the size and thickness of the melanoma lesion. 

Along with a WLE, a sentinel lymph node biopsy is often done. This surgery identifies the first lymph node closest to the melanoma using a special dye. This helps the surgeon identify it and remove the lymph node for evaluation of the presence of cancer cells. 

In addition to surgery, other treatments may be recommended based on the stage of the cancer. A commonly used treatment is immunotherapy. Immunotherapy medications are usually intravenous medications that work by helping the immune system see any melanoma cells in the body. This allows the immune system to help fight against melanoma. Examples of immunotherapy include:

  • Yervoy
  • Opdivo
  • Keytruda

Targeted treatment

Targeted treatment for BRAF mutations is available as well. Some people may benefit from the use of these after surgery, to help reduce the risk of melanoma returning. These medications work by interfering with the BRAF pathway melanoma cells use to grow. Examples of BRAF targeted therapy include a medication called dabrafenib. 

Early stage melanoma and Standard chemotherapy

Standard chemotherapy and radiation are rarely used for early stage melanoma. 

 

Melanoma

Posted on by Julie Scott, DNP

What is Melanoma?

Melanoma is a cancer of the melanocytes, the pigment producing cells in the skin. Melanocytes can also be found in other areas outside of the skin, such as the eyes, genitals, and mouth, but melanoma most commonly develops in the skin. 

Risk Factors

The rates of melanoma have been steadily increasing over the years, and it is important to know the risk factors of developing melanoma, which include:

  • History of UV light exposure (tanning beds, sunburns)
  • Having light colored skin and freckles
  • Having moles
  • Family history of melanoma
  • Being biologically male
  • Increasing age

Signs and symptoms

A new mole on the skin or a change in an existing mole should be evaluated. The ABCDEs of moles should be used:

  • A: Asymmetry: the mole size is irregular and each sides of the mole don’t match
  • B: Borders: the borders are irregular or blurred
  • C: Color: the color of the mole is not the same throughout or is changing to different shades
  • D: Diameter: the mole is >6mm
  • E: Evolving: the mole’s shape, size, or color is changing

Diagnosis

If someone has a suspicious skin lesion, they may be recommended to undergo a biopsy. This is the only way to tell if a skin lesion is melanoma or not. A biopsy can be done one of a few ways, either a shave biopsy, punch biopsy, or excisional biopsy. 

A shave biopsy removes the top surface of the skin lesion to be tested for cancer cells. If a melanoma is suspected, this may not be the biopsy that’s ordered, as it may not get the full lesion for evaluation. 

A punch biopsy uses a special tool to get a biopsy and getting into a deeper layer of the skin. This also may not remove the entire lesion, but may be better able to get through to the deeper layers for a more complete evaluation. 

An excisional biopsy removes the suspicious lesion as well as an area of healthy tissue around it for testing. If this shows that the entire melanoma has been removed, it may be a curative procedure. 

When melanoma has been identified from a biopsy, additional testing is often done to learn some of the characteristics of it, such as for the presence of any gene mutations that the cancer may have. One in particular is called BRAF. This gene is seen in about 50% of all melanomas, and if it’s present, may be treated with targeted medications for that gene mutation. 

 

Interested in learning more about Melanoma staging and Treatments? Check out our next article on this topic.

 

Prostate cancer: who is at risk and how to catch it early

Posted on by Julie Scott, DNP

What is Prostate cancer?

Prostate cancer is common cancer in men. About 13% of men will be diagnosed with prostate cancer during their lifetime. It’s important to know that prostate cancer is very treatable, even in its advanced stages. 

Risk Factors

The biggest risk factor men face for prostate cancer is age. It’s rarely diagnosed in men under 40, with the average age at diagnosis of 66 years. In addition to age, other risk factors for developing prostate cancer include being of African American or Caribbean ancestry and having a father or brother who has had prostate cancer. 

Diagnosis

The prostate-specific antigen (PSA) is a simple blood test that can be done to help detect prostate cancer at an early stage. There is not one specific level that officially diagnoses prostate cancer. Still, it can be followed as a trend over time, with an increasing PSA being more likely to be caused by prostate cancer. 

PSA can fluctuate over time and can be elevated due to factors unrelated to prostate cancer. If a man is suspected of having prostate cancer, another testing will need to be done. 

A prostate biopsy will ultimately need to be done to diagnose someone with the disease. There are multiple ways the biopsy can be done, but typically biopsies are taken from multiple areas of the prostate for evaluation. 

Imaging tests such as ultrasound, MRI, CT scan, and PET scan can be done to assess the extent of the disease and provide staging information to see if the cancer is only in the prostate or has spread into lymph nodes or distant areas of the body. 

Treatment

There are multiple treatment options for prostate cancer, and which ones are used depends upon many factors. 

Some men won’t have any treatment, and will be appropriate for “watchful waiting”, and will be followed with imaging and labs every few months, only to be treated if or when the cancer progresses. 

Surgical removal of the prostate may be recommended for some but not all men with prostate cancer. 

Radiation is a commonly used treatment, and can be given through external beam radiation, or brachytherapy. Brachytherapy is the placement of seeds containing radiation directly into the prostate to treat the cancer. 

Hormone suppression is often given for prostate cancer as well. Testosterone is a fuel for the prostate cancer cells to grow, so decreasing the amount of testosterone in the body can help treat the cancer.  

 

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