The Melanoma Program at Smilow Cancer Hospital brings together an extensive, multidisciplinary team to diagnose, treat, and care for patients with melanoma and other skin cancers. Established over 30 years ago, our program includes experts in melanoma surgery, medical oncology, dermatology, pathology, dermatopathology, radiology, genetics, and radiation oncology. Members of the team are national and international leaders in clinical and laboratory research focusing on improving melanoma treatment. From patients who present with an early-stage diagnosis or more complex, metastatic disease, our team is prepared to provide each patient with the most comprehensive and cutting-edge treatment available.
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
Merkel cell carcinoma is a rare, but aggressive, form of skin cancer. The general surgical approach is similar to that of melanoma, in which a wide excision and sentinel lymph node biopsy are performed. Our radiation therapy expert also sees Merkel cell patients as part of our multidisciplinary care approach, along with our medical oncologists. Advanced squamous cell and basal cell carcinomas that are not treatable with surgery alone are also treated by our medical oncologists in collaboration with our radiation therapy expert.
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.