The American Cancer Society estimates that 76,380 people in the United States will be diagnosed with melanoma in 2016, 10,130 of whom will die from the disease.1
Patients with melanoma often report fears about recurrence, unmet information needs, and inability to access to psychological care.2
Cancer Therapy Advisor interviewed Lynn M. Schuchter, MD, chief of the division of hematology/oncology at Penn Medicine in Philadelphia, Pennsylvania, to discuss the questions frequently asked by patients with melanoma during both the diagnosis and treatment phases of care.
Dr Schuchter specializes in the treatment of melanoma and cutaneous malignancies, and was recognized by Best Doctors in America in 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014.
Cancer Therapy Advisor (CTA): What are the most common questions patients with melanoma ask at the time of diagnosis, and how do you tend to respond?
Dr Schuchter: First, not everyone understands what melanoma is. Some people think about skin cancer, which is very common and not serious, so patients may require a better understanding of what this type of skin cancer is.
Of course, patients want to know what the best treatment is, and with that, what is their risk of recurrence and prognosis. Importantly, patients want to know what to know what the best way to be monitored is, and that is advising them on the risk of a brand new melanoma, the importance of seeing a dermatologist on a regular basis, and reducing excessive sun exposure.
Patients also want to know what kind of surveillance is needed for their melanoma: whether they need to have CT scans and why, why do they need to certain doctors, what is the best way to coordinate their follow-up.
CTA: In what ways do you try to reduce patients’ fears or concerns?
Providing honest information in a way that they can understand and being always available for questions, as well as acknowledging with patients that it can be scary.
There is increased anxiety around the time of scans and follow-up studies, so I encourage patients to do things to take care of themselves in preparing for these visits. I also make sure I give patients the results of studies right away so they are not wondering and fearful of the results of these tests.
CTA: What are the most common concerns you hear from patients with melanoma during treatment, and how do you respond to those patients?
Dr Schuchter: For those with stage I to III melanoma, patients want to know what the right surgery they need is and if they need any additional treatment.
For those with stage IV disease, we need to make sure we know their BRAF mutation status, and then we review whether they have a lot of symptoms and significant disease burden. If someone does not have a BRAF mutation, then we are definitely using immunotherapy, and if someone does have a BRAF mutation, we decide if immunotherapy or targeted therapy is the best approach.
Then, we review each of the medications and the side effects. Education about the side effects is really important, especially with immunotherapy and new combination therapy, because these therapies are associated with significant and potentially life-threatening adverse events.
With the targeted therapies that patients are taking every day at home, those agents have their own side effects, like fever and rash, and clinicians need to educate patients about when to call their physician and how to manage those side effects.
Cancer Therapy Advisor: How do you advise patients to prevent a second melanoma or other skin cancers?
Dr Schuchter: We recommend to patients that they reduce excess sun exposure, wear sunscreen, seek shade; those are the types of safe sun practices that we discuss.
- Key statistics for melanoma skin cancer. American Cancer Society website. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-key-statistics. Updated May 20, 2016. Accessed July 21, 2016.
- Kasparian NA, Mireskandari S, Butow PN, et al. “Melanoma: Questions and Answers.” Development and evaluation of a psycho-educational resource for people with a history of melanoma. Support Care Cancer. 2016 Jul 27. doi: 10.1007/s00520-016-3339-3 [Epub ahead of print]