Each patient’s care will be reviewed by our multidisciplinary care team to develop a personalized treatment plan. Clinical trials are also available to patients through Yale Cancer Center, bringing the latest treatment options for melanoma to our clinics to benefit patients.
Smilow Cancer Hospital places great emphasis on taking care of all of our patients’ needs through a network of supportive care services. Nurses with dedicated knowledge and skills related to the treatment of melanoma are available to care for our patients through the continuum of their treatment. Patients and their families also have access to social workers to provide psychosocial support, as well as pastoral support, nutritional counseling, physical therapy, palliative care, and integrative medicine.
After the initial diagnosis—and depending on the presentation of the disease—each patient is evaluated by our dermatologists, surgeons, and/or medical oncologists.
For some presentations of melanoma, particularly in the early stages in which disease has not spread beyond the primary site or lymph nodes close to the primary site, surgery may the preferred initial treatment.
Specialized surgical expertise is essential for the management of melanoma, which can occur on any skin site and even in areas not exposed to the sun. Some melanomas appear in delicate areas such as the face, nose, ear, or hand and often require the expertise of a plastic surgeon. For certain regions of the body, our team collaborates with other highly trained surgical subspecialties, including thoracic surgery and neurosurgery.
In the early stages of melanoma, pathology results from the tumor will determine the risk of developing metastases (spread to distant organs) in the future. If the results indicate a high risk for melanoma metastases, treatments are available to reduce the risk and possibly prevent or delay melanoma recurrence. Adjuvant therapies (or therapies given after surgery) include immunotherapies and targeted therapies for tumors with a specific mutation in the protein called BRAF.
Depending on the melanoma presentation, CAT scans, MRI scans and/or PET scans may be used to determine if melanoma metastases are present in other parts of the body and to determine the extent of involvement of other body sites. In addition to standard of care treatments, clinical trials may be available—and offered if the standard of care treatment is not effective.
Special Types of Melanoma
Melanoma is also known to develop in areas of the body other than the skin. Ocular melanoma is the most common eye tumor in adults. Care is managed through the Ocular Oncology Program at Smilow Cancer Hospital, in collaboration with the Smilow Cancer Hospital Melanoma Program.
Mucosal melanoma is found in the mucosal surfaces of the body which line nasal passages, the anus, vagina, and other areas. With this diagnosis, patients are often first seen by head and neck, gastrointestinal, or gynecologic surgeons. With both diagnoses, our Melanoma Program experts provide input and manage subsequent post-surgical and follow-up care for melanoma patients.
One of the major complications of advanced melanoma is spread of disease to the brain. The disease and treatment of the disease can have important neurologic consequences. Management of disease in the brain requires a highly skilled and experienced team. To care for these patients, we have assembled a multidisciplinary group of expert medical oncologists, neurosurgeons, neuroradiologists, and radiation oncologists to form the Brain Metastasis Program. The team meets weekly to design optimal treatment regimens and effectively manage the neurologic consequences of the disease and its treatment.
Other Types of Skin Cancer
Our Melanoma Program has a long history of recognized and groundbreaking laboratory and clinical research into the causes and treatment of melanoma. Patients with advanced or metastatic melanoma have access to numerous clinical trials at Smilow Cancer Hospital including novel immunotherapy and targeted molecular therapy regimens. Additionally, patients who are no longer eligible for melanoma-specific studies may be eligible for therapies through our Phase I Clinical Trial Program.
The Yale SPORE (Specialized Programs of Research Excellence) in Skin Cancer is the result of a grant awarded by the NIH National Cancer Institute to improve risk assessment, measures for diagnosis and prognosis, and therapies for patients with melanoma. As only one of five sites in the Unites States to receive a SPORE grant focused on skin cancer, Yale is in the unique position of being able to prioritize skin cancer research through several research projects and a career development program.
Yale Cancer Center is also home to several leading melanoma research laboratories, which study the genetics and cellular changes that result in melanoma. Yale researchers developed several mouse models that are used worldwide to study how melanoma forms and progresses, to test new melanoma therapies, and to see how the immune system can be stimulated to fight melanoma.
Melanoma Center Members
James Clune, MDMicrovascular Hand Surgery, Physical Medicine & Rehabilitation, Plastic & Reconstructive Surgery, Surgical OncologyELBRUS James Clune, MD, is a plastic and reconstructive surgeon, a melanoma surgeon and an upper extremity specialist who performs over 800 procedures per year. He treats patients who have cancer and those who have been through traumas. He is highly skilled in performing surgery for the face and extremities, and in peripheral nerve reconstruction. Some of Dr. Clune’s surgeries are highly complex. For instance, when a person loses a limb in a traumatic accident or due to a tumor, he may be part of a team that helps reroute nerves. He is skilled in performing targeted muscle reinnervation, which involves implanting residual nerves from an amputated limb to allow the patient to utilize an advanced myoeletric prosthesis instead. If a patient has lost a finger, Dr. Clune may be part of a surgical team that transfers a toe to replace it. At the Yale Cancer Center, he also treats patients with skin cancer, and soft tissue and nerve tumors, performing surgeries to restore both function and appearance. “I really enjoy working with the melanoma team,” says Dr. Clune. “I am able to be a part of the patient’s care from start to finish. We formulate a surgical plan together, perform the resection and reconstruction and then guide patients through the healing process.” Dr. Clune is an assistant professor of plastic surgery at Yale School of Medicine and recipient of the 2017-18 teaching award in his specialty. Before becoming a plastic surgeon, he spent four years working with Operation Smile, an international nonprofit that provides cleft lip and palate surgeries for children in developing countries. “I had the opportunity to work in 18 countries over this time period and helped coordinate care for thousands of children with congenital deformities,” he says. “To see a child have life-altering surgery regain form and function, and then to see them thrive in a society that once shunned them inspired me to dedicate my career to helping patients using plastic surgery.” After medical school, Dr. Clune completed a postdoctoral research fellowship at Harvard. His six years of training in plastic surgery and melanoma surgery were completed at Yale, followed by an orthopedic fellowship in upper extremity surgery at the University of California, Irvine. This was followed by a fellowship in Spain in complex microsurgery for the upper and lower extremity, and brachial plexus reconstruction. Dr. Clune’s research on melanoma, upper extremity and nerve surgery has been published in numerous peer-reviewed journals. He continues to pursue answers to clinical problems in the laboratory.
Jonathan Leventhal, MDDermatology, Medical Oncology, Melanoma and Onco-DermatologyJonathan Leventhal, MD, is the director of the Onco-Dermatology Program at Smilow Cancer Hospital at Yale New Haven. He treats patients undergoing cancer treatment who experience itchy or painful rashes, as well as hair and nail changes that can result from either their disease or treatment, including chemotherapy, immunotherapy, radiation or stem cell transplantation. “One of the most rewarding aspects of my job is improving the quality of life for patients with cancer who are affected by adverse skin events,” he says. Seeing an onco-dermatologist like Dr. Leventhal can make the difference between a patient being able to continue receiving a cancer treatment or having to be taken off it when the skin conditions become too severe. “If left untreated, some skin, hair and nail conditions can become quite debilitating, even disfiguring and may negatively impact health and ability to perform day-to-day activities,” says Dr. Leventhal. He helps to manage these skin problems so that patients with cancer can continue their treatments and enjoy a better quality of life. In addition to his role at Smilow, Dr. Leventhal, an assistant professor of dermatology at Yale School of Medicine, cares for patients with a wide range of skin conditions in Yale Medicine Dermatology’s New Haven and Branford locations. He performs routine skin cancer screening examinations and also treats general skin problems—from acne to psoriasis to eczema. “Every day I am excited to come to work, treating various skin conditions affecting my patients and helping patients with cancer continue their potentially life-saving treatments,” says Dr. Leventhal. “Skin diseases can impact the way people see themselves and can affect how people feel, both physically and emotionally. My work is particularly gratifying when I can improve my patients' overall comfort, happiness and health.”
Kelly Olino, MDMelanoma and Onco-Dermatology, Sarcoma, Surgical OncologyKelly Olino, MD, is a surgical oncologist with additional training in cancer immunotherapy. She treats skin cancer in patients who range from teenagers to people in their 90s. “I see a wide variety of people, because skin cancer affects everybody, unfortunately,” she says. As a surgeon, Dr. Olino cares for patients in the office and in the operating room, removing skin and soft tissue tumors that occur anywhere on the body, and performing minimally invasive surgeries to treat metastatic skin cancer when it spreads to internal organs. “When I am treating a patient with skin cancer, I think not only about the technical expertise required to perform a given surgery, but more importantly how the surgery fits into the scope of a larger plan for that patient,” says Dr. Olino, who has additional training in immunotherapy, which she describes as a “revolutionary” step in the treatment of skin cancer. Skin cancer specialists were among the first doctors to successfully use immunotherapy, which harnesses the body’s own immune system to target cancer. Dr. Olino decided to become a surgical oncologist partly because the patients she met as a trainee were so appreciative. She, in turn, has always taken the time to make sure each patient fully understands his or her condition and treatment. “Patients should know what's going on. Their families should know. I joke with them all the time. I say to them, “You know, I'm bilingual. I speak “Doctor” and I speak English, so please let me know if I start to speak “Doctor,” because if you don’t understand what I’m doing and why, it's time for me to explain it again.” As an assistant professor of surgery at Yale School of Medicine, Dr. Olino focuses her research on immunotherapy for skin cancer. She is currently part of a team that is looking at novel ways to combine different types of immunotherapies and move those therapies from the laboratory to patient care clinics.