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Consult

Clinician-to-Clinician Update
To schedule a cancer care consultation, referral or appointment
For a dermatology consultation or referral: (Maple Grove)
(Minneapolis)

Melanoma Care Locations

Masonic Cancer Clinic
(Suite 202)
Dermatology Clinic (Floor 3)
University of Minnesota Health
Clinics and Surgery Center

909 Fulton St. SE
Minneapolis, MN 55455

Ridges Cancer Clinic (University of Minnesota Medical Center - Burnsville)
Fairview Ridges Specialty Care Center
14101 Fairview Dr., Suite 200
Burnsville, MN 55337

Southdale Cancer Clinic (University of Minnesota Medical Center - Edina)
Fairview Southdale Physicians Building
6363 France Ave. S, Suite 610
Edina, MN 55435 

Dermatology
(Floor 2, Check-In D)
Hematology/Oncology
(Lower Level)
University of Minnesota Health Maple Grove Clinics
14500 99th Ave. N
Maple Grove, MN 55369 

Northland Cancer Clinic
Fairview Northland Medical Center
911 Northland Dr.
Princeton, MN 55371

Emerging Therapies for Melanoma

Skin cancer remains the most common cancer in the United States with the most recent study estimating the diagnosis in 2012 of more than 5.4 million basal cell or squamous cell carcinomas among 3.3 million people.1 Of the 3 main types of skin cancer (basal cell, squamous cell, and melanoma), melanoma accounts for about 1% of cases but causes the most deaths.1 Recently developed immunotherapies, however, are beginning to alter this outlook, particularly in advanced or metastatic melanoma cases. In 2019, an estimated 96,480 cases of melanoma will occur, resulting in a projected 11,650 deaths.2 Melanoma cases have risen rapidly over the last 30 years, increasing more among men but stabilizing in women, probably due to environmental and occupational differences.3 Genetic and other risk factors contribute to occurrence; however, about 95% of melanoma cases arise from ultraviolet light exposure (sun, indoor tanning), a modifiable environmental factor.4 

As is the case with all skin cancers, screening and early detection is important and can improve survival.1,5 Melanoma is highly curable when detected early, and because it is visible on the skin, about 70% of cases can be detected before metastasis to lymph nodes or other distant sites. Self-examination of the skin and follow-up with physicians on suspicious lesions are key. Individuals with fair skin, red hair, and blue eyes are more susceptible and should pay particular attention to their skin, although those with dark pigmentation are also at risk.1,5 

While most cases of melanoma are treated with surgery, therapies for advanced melanoma also include isolated limb perfusion, chemotherapy, and chemo- and radioembolization. Multiple immunological and biological therapies have recently and markedly improved outcomes in advanced melanoma, although they can pose adverse immune effects. Therapeutic options for advanced melanoma are determined by individual tumor characteristics and can include immunological therapy with checkpoint inhibitors and oral targeted drug therapies. In advanced cases, treatment is determined on a risk-adjusted basis, depending on sentinel lymph node biopsy results and the extent of regional and distant spread of disease.5,6 The 5-year survival rate for patients with melanoma is about 92%.1,3 

With the emergence of immunotherapies, multidisciplinary team management has become important to improving patient outcomes. Teams with oncology and dermatology specialists are best positioned to identify the best treatments and address cutaneous adverse effects arising from treatment with targeted and immunological therapies. (See case study for further discussion.) 

For clinical researchers, the high immunogenicity of melanoma tumors can help elucidate mechanisms of immune recognition and proves useful in the development of new immunotherapeutic strategies.5,6 A growing number of immune-based therapies are being tested at the University of Minnesota in several clinical trials. One trial examines the autologous adoptive cell transfer of tumor-infiltrating lymphocytes for metastatic melanoma that has not responded to prior initial therapy.7 For this treatment, samples of a patient’s tumor are removed and expanded in the laboratory to activate and expand the immune cells. The activated immune cells are then reinfused into the patient to combat the tumors. Preliminary results suggest the therapy holds promise, and the study is ongoing.8 In another multi-institutional trial, nivolumab and bempegaldesleukin (pegylated-IL2) are combined with a small molecule agonist of toll like receptors 7/8 (NKTR-262) in patients with relapsed disease.9 The drug works in the tumor environment, activating antigen-presenting cells to create new antigen-specific cytotoxic T cells. To find additional studies, visit z.umn.edu/cancertrials.

References 

  1. American Cancer Society. Cancer Facts and Figures 2019. Atlanta, GA: American Cancer Society, 2019 pp 24-25. Accessed February 25, 2019 
  2. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2019. CA Cancer J Clin 2019;69(1):7-34 doi.org/10.3322/caac.21551.
  3. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271-289. doi: 10.3322/ caac.21349. Epub 2016 Jun 2. 
  4. Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31-54. doi: 10.3322/caac.21440. 
  5. Tarhini AA, Lorigan P, Leachman S. Operable melanoma: screening, prognostication, and adjuvant and neoadjuvant therapy. Am Soc Clin Oncol Educ Book. 2017;37:651-660 doi: 10.14694/EDBK_174930. 
  6. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cutaneous Melanoma. Version 1.2019. Nov 1, 2018. NCCN.org Accessed Jan 31, 2019. 
  7. InnovaTIL-01, Study of Lifileucel (LN-144), Autologous Tumor Infiltrating Lymphocytes, in the Treatment of Patients with Metastatic Melanoma (LN-144). NCT02360579. Accessed February 25, 2019. 
  8. Sarnaik A, Thomas S, Davar D, et al. Safety and efficacy of cryopreserved autologous tumor infiltrating lymphocyte therapy (LN-144, lifileucel) in advanced metastatic melanoma patients following progression on checkpoint inhibitors. Poster O22. Society for Immunotherapy of Cancer in Washington, DC, November 7-11, 2018. Accessed February 25, 2019. 
  9. A Study of NKTR-262 in Combination with NKTR-214 and with NKTR-214 Plus Nivolumab in Patients with Locally Advanced or Metastatic Solid Tumor Malignancies (REVEAL), NCT03435640. Accessed February 25, 2019.

When to refer

University of Minnesota Health offers multidisciplinary care for patients with melanoma and skin cancers. Our care team includes general dermatologists, dermatologic surgeons, dermatopathologists, medical oncologists, surgical oncologists, radiation oncologists, and general, plastic, and head and neck surgeons. 

Developed through the joint efforts of dermatology and oncology, our multidisciplinary approach to melanoma and pigmented lesion treatment is designed to facilitate screening and prompt care for patients with newly diagnosed malignant melanoma or at high risk of developing melanoma. The specialist team evaluates patients with a personal or family history of melanoma and those with multiple or suspicious nevi. Patients with a new diagnosis of skin cancer can typically be seen within 1 week of a new diagnosis. We have multiple cancer care locations within the Twin Cities and outstate Minnesota. 

We offer Mohs microsurgery in appropriate cases of melanoma and work with surgical oncology for sentinel lymph node evaluations. Treatment regimens for patients with melanoma are tailored to the individual patient and include new therapies and clinical trials for advanced melanoma. Therapies include T-VEC, isolated limb perfusion chemotherapy, chemoembolization, radioembolization, and high-dose interleukin-2 therapy. Through our partnership with the Masonic Cancer Center, University of Minnesota, we offer access to new cancer therapies under clinical trial participation. As a National Cancer Institute-designated comprehensive cancer center, the Masonic Cancer Center participates in multiple clinical trials assessing cutting-edge therapies for melanoma. 

To schedule a physician meeting or to visit our facility, contact Melinda Tuma, System Manager, Outreach Services at 612-273-9947 or by email

The Masonic Cancer Center is one of only 49 NCI-designated comprehensive cancer centers in the United States, a designation awarded only to institutions that make ongoing, significant advances in cancer research, treatment, and education. To view all current, active clinical trials available through University of Minnesota Cancer Care, please visit z.umn.edu/cancertrials.

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