Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye.
The 4 Stages of Melanoma: The Deadliest Form of Skin Cancer
Rich Joseph is a medical oncologist at Mayo Clinic in Jacksonville Florida his clinical expertise is in cutaneous malignancies and cute including melanoma, other skin cancers and also treat genitourinary malignancies as well
What is melanoma:
Melanoma is distinct from other skin cancers and that it is usually a proliferation of pigmented cells although not always… a melanoma can also originate in different parts of the mucosal tract including the head and neck , Gastrointestinal tract as well as on the bottoms of the palms and the soles which usually doesn’t occur in other types of skin cancers.
Melanoma is the most deadly form of skin cancer because it is the cancer that is most likely to spread to other organs and other types of skin cancers rarely spread from outside of the surface of skin and the ability of the melanoma cancer to metastasize makes it the most deadly in a stage one melanoma has a cure rate of about 95% if you catch it early that’s great.
is something that is still in the skin but has not spread to the lymph nodes or the rest of the body that still has a pretty high chance of cure of catching it early somewhere in the range of 70 to 80% chance of cure… a stage three melanoma is when the melanoma has escaped from the skin and gone to the lymph nodes and we divide stage three.
In the stage three B and C depending on how many lymph nodes are involved in the cure rate there drops all the way down as low as 20% if many lymph nodes are involved and as high as 60 to 70% if only one lymph node is involved.
A stage four melanoma is a melanoma that is left the lymph nodes and gone to the to distant parts of the body and there the survival is much less the overall average median survival we’re explaining in the order of months to… maybe a year or so however those numbers are getting better with our newer therapies
melanoma patients usually at two phases the first phase is if they are diagnosed and then they have a lymph node that is positive traditionally the lymph node is removed by the surgeon and then they come to see me to help them prevent the melanoma from recurrent in the rest of their body and at Mayo Clinic.
Stage four Melanoma
We have several clinical studies that are geared towards preventing melanoma from being spreading to the rest of the body which we call stage four melanoma VORs rather than stage three melanoma does predominantly exist in older population however the amount of numbers in the younger population is much higher than other types of lethal cancers we still have a long way to go to eradicate melanoma or completely cure the majority of the patients but before the last five years we were talking about getting responses in helping maybe five to ten percent of patients now we’re moving that bar up to anywhere to 20 to 50 percent of patients of causing them long-term remissions which is a huge step forward but obviously leaves us with another 50% to improve upon as well so a long way to go but we’ve come a long way.
We had seen with the earlier presentation that progression free survival median observed was just a hair under 15 months, which was quite striking since it was a few months longer than had ever been achieved with either of the other BRAF/MEK combinations, or for that matter, any other melanoma therapy that has emerged recently including immune checkpoint antibodies. The response rate was quite similar between encorafenib and benimetinib and the other BRAF/MEK combinations, allowing for cross trial comparisons and the challenges in performing such direct comparisons. Overall survival results, one of the really striking features was that overall survival as was the case with progression-free survival was also markedly longer than seen with either of the previously seen BRAF/MEK combinations or other therapies including immunotherapy.
The median survival of just over 33 months is really quite a striking result. With the progression-free survival and the overall survival, they really were proportionally longer to the same degree compared to these previously established standard of care therapies. A major point of caution is we didn’t directly compare the new BRAF/MEK combination to the old BRAF/MEK combination.
We have the internal control of encorafenib itself versus vemurafenib, showing that that was superior, so I think it’s credible that this combination really does produce ultimately the best outcome. Within this study, median progression-free survival under 15 months, meaning overall survival over 33 months, really is quite a striking milestone in this disease. While I and coinvestigators are very excited about that right now, since this is a lethal and aggressive disease, another key point is that patients typically on this therapy for quite a long time with median progression-free survival of 15 months, half the patients go on for longer than that. Therefore, safety and tolerability are critically important.
We had learned in the phase I trial and very much confirmed in this trial, is that the tolerability of this regimen is also apparently best in class. It shares some of the same toxicities as other BRAF/MEK combinations, but actually dropped a couple of the major toxicities associated with those other approved regimens, just about completely, in fact, and so that is a big bonus for patients who are on this therapy. When we consider the efficacy, outcome data, and tolerability profile, it feels like an advance on both sides.
Metastatic Melanoma Survivor’s Advice
All the doctors here have options there’s always encouragement but hope is the key that you’ve got to… you’ve got to have hope and believe me there’s times I lost hope that’s when I turn to prayer that’s when I turn to family but when you have hope you can always get through it and you can always come out successful not always but you can come out successful but you got to have the attitude and I think attitude is everything I can’t tell you how many times I heard from people brothers sisters friends that said how do you do this I don’t know how he’s doing it and when I and I was all…
I would always tell them you don’t have any idea what you can do until you’re pushed you can’t fathom me doing this or yourself doing this but believe me if you if you face it you might be dying you’ll do anything and it’s not easy but believe me I’m not the only one that’s being cancer …
don’t look too far ahead because it can be hard on you on your psyche stay in the moment and don’t let it get away from you because one day is all anybody really has one day to the next nobody’s promised a future that’s why you got to make the best out of every day you have
whether you’re healthy or not healthy, because it truly is special that’s why they call it a gift so stay in the present know that you can do it sometimes you got to dig down deeper than what you’ve ever done deeper before which I did believe me I didn’t know I could do it if I hadn’t done it I’d probably say I couldn’t do it either and I wanted to give people the hope that you can do it and no matter how bad you it might be because I’ve been there with you I’ve been at the lowest of the low but I made it through with the great doctors of course but then the faith family and friends is what carries you to the finish line.