It is estimated that more than 62,000 people in the United States this year will be diagnosed with primary melanoma — the most serious type of skin cancer. Melanoma is also the sixth most common cancer in men and the seventh most common in women. Cancer.Net talked with John Kirkwood, MD, to learn more about the latest news and research in melanoma and information for survivors.

Q: What is the difference between melanoma and the non-melanoma skin cancers, such as basal cell and squamous cell skin cancer?

A: Melanoma strikes approximately 60,000 patients a year, and approximately 8,000 deaths from this disease occur each year, whereas non-melanoma skin cancers strike more than 1 million patients a year, but cause only a small fraction of deaths. Melanoma surgery requires excision (removal) of a margin of skin that depends upon the depth of invasion and ranges generally from 1 to 2 centimeters (cm). This should be performed in association with the evaluation of the regional, draining lymph node (a tiny, bean-shaped organ that fights infection) status in a procedure called sentinel node biopsy for those patients with a recurrence risk of more than 10%. A higher risk is generally associated with a depth of invasion of 1 millimeter (mm) or greater, or ulceration (formation of a break in the surface of the skin) over the melanoma, or when a biopsy shows a tumor that extends to the deep margin (area of normal-appearing tissue surrounding the melanoma).

Q: What is the most important thing for people to know about melanoma if they are diagnosed and planning surgery?

A: A wide excision should be done with sentinel node evaluation if the primary melanoma depth is 1 mm or greater, or if there are any other features that are associated with greater risk of spread (such as an ulceration, or if the initial biopsy of the margin shows that it is cancerous).

Q: What are some advances in the prevention of melanoma recurrence that may add to the surgical treatment of melanoma?

A: Studies have shown that an immunotherapy (a treatment designed to boost the body's natural defenses to fight cancer by using materials either made by the body or in a laboratory to bolster, target, or restore immune system function), called high-dose interferon alfa-2b (Intron) given intravenously (through a vein) five days a week for four weeks, and then under the skin (like insulin) three days a week for 48 weeks (11 months), may reduce recurrence risk and improve survival. This treatment was approved for adjuvant therapy (treatment after surgery) of patients with high-risk melanoma deeper than 4 mm at the primary site and/or melanomas that have spread to lymph nodes. This therapy was approved by the U.S. Food and Drug Administration 12 years ago and has been confirmed by two subsequent reviews. Unfortunately, no other therapy or combination of treatments has shown to be similarly effective. Recent studies have shown correlations between the development of autoimmunity (a condition where the body recognizes its own tissues as foreign substances and directs an immune response) and the benefit of this therapy, which suggests an immunological basis of the benefit of therapy. Studies of neoadjuvant treatment given before surgery also have demonstrated that this treatment is associated with an arrival of immune cells into the tumor, which adds support to the conclusion that interferon is acting like a vaccination to redirect or polarize the immune response to destroy cancer cells.

Q: What are some ways people who have been treated for melanoma can become involved in their care to prevent new melanomas from arising in their skin?

A: Skin self-examination is a reasonable practice for all patients with melanoma to detect early and highly curable melanoma lesions (areas of abnormal tissue) before they have had the chance to grow and spread.

Q: What follow-up care is recommended for people treated for melanoma?

A: Regular follow up at intervals of three to four months for the first couple of years and at intervals of six months for years three to five and annually thereafter are reasonable. The follow-up care may include physical examination of the skin and lymph nodes, as well as examinations of other vital organs. Chest x-rays and laboratory blood tests, depending upon the patient's risk profile and prior treatment, may also be reasonable.

Q: What other research is ongoing with melanoma?

A: Extensive research is ongoing in a number of melanoma centers across the country, like the Pittsburgh Cancer Institute, where more than 26 investigators from multiple disciplines of basic and clinical research work together to discover the key factors that promote the development of melanoma (progression factors) and how the host response (immune response) to melanoma may recognize and control the emerging tumor. Research is ongoing to improve upon the two drugs that are approved for the treatment of melanoma, which may overcome the mechanisms of resistance to these treatments. In addition, multiple new treatments that may improve upon the host immune response may improve the treatment and prevention of melanoma.

Dr. Kirkwood is director of the University of Pittsburgh Cancer Institute's melanoma program and is a member of the Cancer.Net Melanoma & Skin Cancer Advisory Panel.

More Information

Cancer.Net Guide to Melanoma

Cancer.Net Guide to Skin Cancer

Cancer and the Summer Months

Protecting Your Skin from the Sun

Additional Resources

American Academy of Dermatology: Melanoma/Skin Cancer Detection and Prevention Month

Melanoma International Foundation

Melanoma Research Foundation

The Skin Cancer Foundation

The William S. Graham Foundation for Melanoma Research, Inc. (The Billy Foundation)