Treatment of metastatic and advanced melanoma

Dr. Adilardi Pasquale, Scientific Director, Oncogenome Precision Oncology

Onco-Dermo-Surgery and Precision Oncology

It requires a highly specialized assessment and a personalized treatment plan. Depending on the stage of the disease, the biological characteristics of the melanoma, and the patient's condition, immunotherapy, targeted therapy, surgery, radiotherapy, TILs, and clinical trials may be considered.

Dr. Adilardi's team offers a specialized evaluation of malignant melanoma, with a particular focus on therapeutic strategies for advanced and metastatic melanoma and the most modern cancer immunotherapy options.

Melanoma treatment: how is it chosen?

The choice of melanoma treatment depends mainly on the stage of the disease, its location, the possible involvement of the lymph nodes or other organs, and the molecular characteristics of the tumor.

Before defining the therapeutic path, histological tests, diagnostic imaging and, in appropriate cases, molecular tests may be necessary to identify any genetic alterations relevant to the therapy.

The goal is to build a personalized treatment based on the clinical situation of the individual patient.

Melanoma treatment based on stage

Stage 0, I, and II melanoma: treatment of early melanoma

In early-stage melanoma, treatment is generally surgical and consists of removing the lesion with adequate margins.

Depending on the thickness of the melanoma and other prognostic factors, a sentinel lymph node biopsy may be indicated, useful for evaluating the possible spread of the disease to the regional lymph nodes.

Management of early-stage melanoma is determined based on histological examination and specific tumor characteristics.

Stage III melanoma: lymph node treatment

Stage III melanoma may involve regional lymph nodes or tissues near the tumor site.

Treatment may include:

• surgery;
• immunotherapy;
• targeted therapy, when specific molecular alterations are present;
• combinations of treatments;
• possible participation in clinical studies.

The strategy is chosen considering the extent of the disease, the characteristics of the melanoma and the treatments already carried out.

Stage IV Melanoma: Treatment of Metastatic Melanoma

Stage IV melanoma is a form of metastatic melanoma in which the disease has spread to distant sites, such as other organs or tissues.

Treatment of metastatic melanoma may include several therapeutic strategies, including:

Immunotherapy for melanoma

Melanoma immunotherapy is one of the main strategies used in the management of advanced disease. These treatments act on the immune system to stimulate a response against tumor cells.

The choice of immunotherapy depends on the clinical picture, the extent of the disease, previous treatments and the individual characteristics of the patient.

Targeted therapy for melanoma

In some patients with metastatic melanoma, specific molecular mutations can be identified that allow the use of targeted therapies to be evaluated.

For this reason, in appropriate cases, molecular characterization of the tumor can represent an important part of therapeutic planning.

Surgery for metastatic melanoma

Surgery for metastatic melanoma may be considered in selected situations, such as when effective control of a specific disease site can be achieved.

The surgical decision must be integrated into a multidisciplinary oncology pathway.

Radiotherapy

Radiotherapy in advanced melanoma can be used to control specific areas of the disease, depending on the location of the metastases and the treatment goals.

Therapy TO

For selected patients with advanced melanoma, tumor-infiltrating lymphocyte (TIL) therapy may be considered, a cellular immunotherapy approach that uses lymphocytes harvested from the tumor and processed for use in the therapeutic pathway.

Suitability for TIL therapy depends on specific clinical criteria and must be assessed by a specialized team.

Clinical trials for advanced melanoma

Clinical trials in metastatic melanoma can offer access to innovative therapeutic strategies for selected patients.

The possibility of participating in a clinical trial depends on the inclusion criteria and the characteristics of the disease.

Recurrent melanoma: what to do when the tumor returns?

Recurrent melanoma requires further evaluation by a specialist. Recurrence may occur locally, in the lymph nodes, or in more distant locations, and treatment depends on the location and extent of the disease.

The revaluation may include:

• diagnostic imaging tests;
• review of the histological examination;
• molecular tests;
• assessment of disease status;
• analysis of previously performed treatments;
• evaluation of new available therapeutic options.

In the event of a recurrence, it is therefore important not to consider previous treatment in isolation, but to reevaluate the entire therapeutic pathway.

How is melanoma treatment personalized?

There is no single treatment that works for all melanoma patients.

The therapeutic choice may depend on:

• melanoma stage;
• size and characteristics of the tumor;
• lymph node involvement;
• presence of metastases;
• molecular characteristics of the tumor;
• general conditions of the patient;
• treatments already received;
• response to previous therapies;
• possible availability of clinical studies.

Dr. Adilardi's team's approach begins with a detailed case assessment to identify the most appropriate treatment options based on the patient's diagnosis and goals.

When to see a melanoma specialist?

It is advisable to consult with a specialist experienced in the treatment of melanoma when the diagnosis presents more complex characteristics or when it is necessary to define an advanced therapeutic path.

A specialist assessment can be particularly useful in cases of:

• high-risk melanoma;
• deep melanoma;
• suspected lymph node involvement;
• melanoma in stadio III;
• stage IV metastatic melanoma;
• melanoma recurrence;
• disease progression after therapy;
• need to evaluate immunotherapy or targeted therapy;
• need for a second opinion;
• evaluation of innovative therapies or clinical studies.

Second opinion for melanoma

A second opinion on melanoma can help the patient better understand the diagnosis, prognosis, and possible treatment options.

This may be particularly important in cases of advanced, metastatic, or recurrent melanoma, where the choice of therapeutic strategy may require the integrated evaluation of several specialists.

Metastatic melanoma treatment: why rely on a specialized team?

The management of advanced and metastatic melanoma may require multidisciplinary expertise and in-depth knowledge of various therapeutic options.

Surgery, immunotherapy, targeted therapies, radiotherapy, TILs, and clinical trials may have different indications depending on the individual case.

A specialist assessment allows us to analyze the clinical situation as a whole and identify the therapeutic options to discuss with the patient.

Looking for a melanoma specialist?

Have you been diagnosed with advanced, metastatic, or recurrent melanoma? Want to understand what treatment options are available for you?

Request a specialist evaluation for the treatment of melanoma and bring with you the clinical documentation, diagnostic tests and reports of any therapies already undergone.

Contact Dr. Adilardi's team for a personalized evaluation of your case.

FAQs about melanoma treatment

What is the treatment for metastatic melanoma?

Treatment of metastatic melanoma is personalized based on the location and extent of the disease, the tumor's molecular characteristics, and the patient's condition. It may include immunotherapy, targeted therapy, surgery, radiotherapy, TILs, and clinical trials in selected patients.

Can metastatic melanoma be treated with immunotherapy?

Yes. Immunotherapy is one of the main therapeutic strategies used in advanced and metastatic melanoma. The choice of treatment should be made by a specialist based on the individual clinical situation.

When is targeted therapy indicated in melanoma?

Targeted therapy may be considered when melanoma presents specific molecular alterations for which available therapy is available. Molecular characterization of the tumor may therefore be important in patients with advanced disease.

What is TIL therapy for melanoma?

TIL therapy, or tumor-infiltrating lymphocyte therapy, is a form of cellular immunotherapy intended for selected patients with advanced melanoma. Eligibility must be assessed by a team specifically experienced in this type of treatment.

When is it useful to ask for a second opinion for melanoma?

A second opinion may be helpful after a diagnosis of high-risk melanoma, in cases of advanced or metastatic disease, recurrence, or when evaluating different treatment strategies.

Which specialist treats metastatic melanoma?

The management of metastatic melanoma may involve an oncologist, surgical oncologist, radiation oncologist, pathologist, and other specialists. A multidisciplinary team allows for the integration of different expertise in defining the treatment plan.

Request a melanoma evaluation

Treatment of melanoma must be personalized based on the diagnosis and characteristics of the disease.

Request a specialist evaluation to understand the treatment options available for your case.

I have a suspicious mole, what should I do?

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