Sunlight provides the energy that powers all life on earth. However, those radiant waves also have a darker side. They are a leading suspect in cellular changes that lead to melanoma, a cancer that can rapidly become lethal as it moves into surrounding lymph nodes and beyond.
Surgical treatment can be curative if the melanoma is detected in time and both the lesion and affected nodes are removed before it breaks free into the body to do its worst.
In melanomas located on legs and the lower body, nodes in the pelvic area tend to be the first targets of the disease. Traditional surgery to remove them requires a 12-inch incision from abdomen to upper thigh, often requiring a hospital stay of several days and recovery time that can delay chemotherapy or immunotherapy that might be needed. The long scar and discomfort can make the situation more difficult for patients, especially those with diabetes or other conditions that may inhibit healing.
A novel laproscopic surgery developed at UAB by Carlo Contreras, MD, eliminates many of these difficulties and helps patients recover faster. Contreras, an assistant professor in the Division of Surgical Oncology and an associate scientist with the UAB Comprehensive Cancer Center, recently presented a video detailing the minimally invasive procedure at a meeting of the American College of Surgeons.
"This approach combines two laparoscopic procedures that have been used to treat gynecological and urological conditions. Instead of the 12-inch incision in traditional surgery, we do six small incisions to access both inguinal and iliac lymph nodes," Contreras said. "This procedure has worked well in most patients. From time to time, a lymph node may be so large or placed so that I can't adequately visualize the blood supply. In those cases, it's necessary to switch from the laparoscopic approach to a larger incision.
"My patients are happy to hear that they can usually go home the next day rather than having to deal with the disruptions of a long hospital stay. They get back to their life and the things they enjoy faster, with less pain and without the inconvenience of a long recovery. Also important, depending on the case, patients may need to begin chemotherapy or immunotherapy as soon as possible. In a cancer as aggressive as melanoma can be, faster treatment can make a critical difference."
In addition to removing lymph nodes in melanoma cases over the past two years, Contreras has also used the laparoscopic procedure in less common soft tissue cancers, squamous cell and Merkel cell carcinomas. This technique also has diagnostic applications. The procedure is currently available in Alabama only at the UAB Comprehensive Cancer Center.
Melanoma can occur anywhere on the skin and even in the eyes. If it escapes the lymph nodes, it begins to attack other tissue and can make its way to the brain.
Though color can vary, and changing color can be a sign of danger, melanoma often begins with a dark, highly pigmented mole that starts changing. Moles with asymmetric, irregular borders that begin to grow should be examined promptly, and people with close relatives who have been diagnosed with melanoma should consider seeing a dermatologist for a baseline evaluation so any dark moles or suspicious lesions can be tracked over time. Patients with red hair, light skin tone and chronic sun exposure are particularly at risk.
"There seem to be more melanoma cases in recent years," Contreras said. "Thinning ozone may have something to do with it, but we hope physicians will caution their patients to use adequate protection every time they are going to be in the sun--SPF 30 and above. Tanning beds should definitely be avoided. There is strong data linking them to melanoma."
Prevention is far better than even the best cure, but it is good to see advances in melanoma treatment that are reducing the toll it takes on patients. In the future, this novel approach to node removal should bring easier treatment to more patients and could offer applications to lessen the impact of other diseases and cancers that impact inguinal and iliac lymph nodes.
