The Johns Hopkins Department of Radiation Oncology and Molecular Radiation Sciences is a leader in developing radiation strategies that target tumors while minimizing damage to surrounding tissues. Johns Hopkins radiation oncologists use the most advanced treatment planning systems including 3-D imaging, Intensity Modulated Radiation Therapy (IMRT), and TomoTherapy, which help to limit damage to normal tissue while increasing the focus of radiation beams on the tumor. Hopkins researchers also study more effective radiation treatment methods in the laboratory that may soon become the next generation of clinical advances. Johns Hopkins has two radiation oncology facilities, one located in the Harry and Jeanette Weinberg building of the Johns Hopkins East Baltimore Campus and a satellite facility at Green Spring Station in Lutherville, Maryland.
Information You Need to Know
While surgery generally is the first-line treatment for melanoma, Johns Hopkins experts may also recommend radiation therapy following surgery depending on your type of tumor. Radiation therapy is most commonly recommended for patients whose tumor has spread beyond the skin to other areas of the body, or in cases where the primary tumor’s location or extensive nature makes it difficult to operate. It also can be helpful after surgery in situations associated with a higher risk of recurrence such as following resection of a desmoplastic melanoma or following surgery for locally recurrent disease. Radiation can be used to reduce pain or pressure symptoms from rapidly enlarging metastic lesions.
The machines generally used for melanoma treatment are linear accelerators. These machines deliver a uniform dose of high-energy X-ray to the tumor, destroying cancer cells while sparing the surrounding normal tissue. Johns Hopkins is one of the few centers in the region with this equipment. This machine and its associated computerized treatment planning software enable physicians to locate and irradiate relatively small targets in the head with extremely high precision. Intense doses of radiation can be given to the targeted areas while sparing the surrounding tissues.
Patients undergoing radiation for treatments to individual symptomatic lesions may have five 15-minute sessions a week for up to five weeks. Side effects depend on where the melanoma is located but can include fatigue and skin irritation.
Radiation therapy may be recommended for older patients with lentigo maligna and lentigo malignant melanoma, also known as Hutchinson melanotic freckle. This type of melanoma typically occurs in sun-damaged skin of the head and neck in people over the age of 40, and peaks when patients are in their 70s or 80s. Lesions usually have slowly enlarged for five to 10 years before patients see a doctor. Although surgery offers the best outcome, with greater than 90 percent cure rates and the highest likelihood of preventing death, it may not be feasible for large lesions of the face.
Radiation sometimes is used to reduce pain or shrink tumors in patients with melanoma that has spread to the brain, organs or other areas of the body. In these situations, the typical treatment course will be 2-3 weeks in duration. The radiation oncologists will work with other team members to coordinate radiotherapy with surgery, systemic therapy and other types of treatment such as radiofrequency ablation, vertebroplasy, etc.