The vast majority of cases occur in the skin and are called cutaneous melanomas. These can be further subdivided into four major types. The most common one is superficial spreading, followed by nodular melanoma. Other cutaneous melanomas include lentigo maligna and acral lentiginous.
But melanomas can also develop in melanocytes located in other areas, including the eye (uveal and conjunctival melanomas) and mucosal surfaces throughout the body (mucosal melanoma), such as the gastrointestinal tract.
Desmoplastic melanoma is another distinct subtype that occurs in skin regions with chronic sun exposure. Other very rare subtypes include primary central nervous system melanoma, which occurs in the leptomeninges (the lining of the brain and spinal cord) and melanoma of soft parts (also known as clear cell sarcoma), which arises in the dermal layer of the skin and other soft tissues.
At MD Anderson, treatment is tailored to the specific needs of each patient. So, we take into consideration the type of melanoma, its stage and any other medical issues a patient might have.
What are the latest advances in melanoma diagnosis and treatment?
Over the past decade, the Food and Drug Administration (FDA) has approved a number new drugs for the treatment of melanoma.
In the immunotherapy category alone, there are ipilumumab, pembrolizumab, and nivolumab, plus the combination of ipilumumab and nivolumab taken together. These are given through an IV.
There are also three FDA-approved oral targeted therapy drug combinations for melanoma patients with a BRAF mutation: vemurafenib and cobimetinib, dabrafenib and trametinib, and encorafenib and binimetinib.
Other approaches for treating advanced melanoma include injecting an oncolytic virus called talimogene laherparepvec (T-VEC) directly into the tumor.
Not all of these therapies will work for everybody, of course, but it’s still really exciting to have them. Because now, patients have many great FDA-approved medications available, and numerous clinical trials they can join, should they exhaust all current treatment options.
We’re seeing some really amazing results, too. Patients who would’ve lived maybe 4 to 6 months after being diagnosed with a melanoma brain metastasis before, for example, have a chance of living for years. And some are seeing complete responses. So, while we still have a lot more work to do to help our patients, having melanoma today is very different from having melanoma a decade ago.