Hopkins Health

Bringing Wisdom to Bear

Surgeon Julie Lange, oncologist William Sharfman and dermatologist Mona Mofid take physician consultation to a new level at the Melanoma Group’s weekly meetings.

It’s an early Tuesday morning in mid-June as 11 members of the “Melanoma Group” sit down in a fifth-floor conference room at Johns Hopkins.

What follows is inside stuff—the collective knowledge of some of the world’s top clinicians and researchers in the field of melanoma. Here they share new ways to detect and treat the disease, the latest studies on emerging therapies and new technologies, and their illuminating experiences in caring for the most complex melanoma patients.

“Each of us as treating physicians brings a different perspective, and the blending of these perspectives helps us bring the best diagnosis, the best combination and sequence of treatments to patients,” says surgical oncologist Charles Balch, M.D., the author of Cutaneous Melanoma, considered the bible of the disease. “So that is what we do on Tuesday mornings—we bring our collective wisdom to bear.”

Treatment of melanoma, Balch explains, typically involves the coordination of four or five certified specialists, including dermatologists, medical oncologists and cancer surgeons like himself. The group, officially the Melanoma and Cutaneous Oncology Group, takes such coordinated consultation to another level, especially for the patient with the complex or rare presentation of melanoma.

Dermatologist Mona Mofid, M.D., for example, presents the case of an elderly patient from Europe whose deep, inoperable melanoma has spread to his liver and lung. She’d like to send him to medical oncologist William Sharfman, M.D., sitting across the table.

Sharfman’s use of high-dose Interleukin-2 therapies has resulted in partial or complete remissions for up to 20 percent of his metastatic melanoma patients. Of course, he says to Mofid, and suggests that thalidomide treatments over the next six weeks may shrink the patient’s tumors. If the patient responds, they can continue the treatments when he returns to his home country.

Another member of the group describes the case of a 30-year-old melanoma patient who would like to have a baby. One problem—the patient is on a vaccine trial that may compromise her immune system. Would pregnancy put her at further risk? There’s no research that pregnancy influences survival in melanoma, responds dermatologist Daniel Sauder, M.D. He then distributes two recent research papers—one on immunotherapy for melanoma, published in Trends in Melanoma; the other on pregnancy and early-stage melanoma, in the Journal of the American Cancer Society.

Other cases and clinical trials are reviewed, and new biopsy techniques, drug therapies and laser treatments discussed during the remainder of the 90-minute meeting. Dermatopathologist Terry Barrett, M.D., for example, mentions new “staining” techniques he’s using to accurately diagnose suspected but “ambiguous” melanoma tissue specimens that come to his lab from the community.

“The ones that are difficult to detect are the ones we end up getting here,” Barrett says. “That’s why we’ve gotten pretty good at pulling the zebras out of the pack.” And that, Mofid says, translates into “amazing care” for the patient with melanoma, a deadly disease that can be cured with early detection.