A patient slated for aggressive melanoma surgery decided to first seek out a second opinion from a multidisciplinary melanoma care center. When the center’s dermatopathologists reviewed her lymph node biopsy slides, they discovered the cells were not melanoma, but rather harmless intranodal nevus cells, sparing the patient needless surgery.
This case dramatically demonstrated the focus of Saturday’s session, “Utility and Value of Multidisciplinary Melanoma Care: From Initial Diagnosis to Follow-up Care” (F093). It emphasized that a collaborating team of dermatologists, dermatopathologists, surgical oncologists, and medical oncologists brings a level of expertise to melanoma care that clinicians in isolation find difficult to match.
“Medicine as a whole is heading toward consolidating care, so it has become important in cancer care — including melanoma — to approach it from a multidisciplinary perspective, which is a form of personalized care. And this is in parallel to personalized therapy where the molecular drivers of a tumor can aid in best treatment algorithms,” said course director Suraj S. Venna, MD, medical director of the Melanoma Skin Cancer Program at the Inova Schar Cancer Institute in Fairfax, Virginia. “Multidisciplinary melanoma care is an efficient, comprehensive way to manage patients with newly diagnosed melanoma, and it conveys to patients that melanoma is a serious disease.”
In contrast to patients making a series of appointments with dermatologists, surgeons, oncologists, and other care providers on their own, the multidisciplinary melanoma care clinic is a one-stop shop. In one morning, a patient’s case is evaluated from start to finish by a team of melanoma experts. A patient care coordinator manages future visits to specialists along the melanoma care continuum, said Dr. Venna.
The melanoma care team follows best practices by adhering to national practice guidelines, examining pathology for accurate diagnosis, applying the most effective treatments for specific diagnoses, and having longitudinal follow-up plans for periodic skin checks. A pivotal moment in the care continuum involves a second opinion of the initial biopsy slides by dermatopathologists.
“Accurate diagnosis and microstaging of the primary melanoma are the strongest predictors of patient outcomes, so there is great value in second opinions about the pathology of the melanoma,” Dr. Venna said. “In 10 to 15 percent of cases, there is a change in the diagnosis or the microstaging of the melanoma that can affect treatment recommendations and outcomes.”
Saturday’s session also addressed guidelines from the seventh edition of the American Joint Committee on Cancer staging system and from the updated National Comprehensive Cancer Network. Dr. Venna encourages dermatologists to apply national guidelines as essential starting points in treatment decisions. However, it is important to weigh all variables.
He also encourages dermatologists in all walks of the specialty to be partners in life-saving early melanoma detection.
“Patients are looking to us to help detect all forms of skin cancer, most especially melanoma. The literature clearly shows that of all ‘detectors’ of melanoma — from patient self-detection to primary care — dermatologists are best at catching melanoma early,” Dr. Venna said. “But we’re only able to do this if we’re looking for melanoma.
“We should implement opportunistic screenings whenever possible. A skin check does not take as much time as we think. Multidisciplinary care, when done correctly, will engage the referring dermatologist to convey to the patient that we are all in this together and that the patient has a care team.”