A deep research bench will distinguish Hopkins’ new center. Researchers and clinicians at Johns Hopkins have been teaming up to work on melanoma for years. But there was never a formal structure or a mission to translate basic science into the clinical treatment of skin cancer. That is, until Suzanne Topalian arrived this year from the National Cancer Institute to join the surgery faculty. Topalian, a plastic surgeon, was charged with bringing together researchers and clinicians from different disciplines into a comprehensive bench-to-bedside center for treating a rare but deadly form of cancer. The Hopkins Melanoma Program, which opened June 1, is integrated with the Sidney Kimmel Comprehensive Cancer Center and is supported by its core resources for clinical and basic research. Hopkins sees approximately 250 to 300 patients a year with melanoma, a severe form of skin cancer that is prone to spread. It accounts for only 4 percent of new skin cancer cases in the United States annually, but about 80 percent of skin cancer deaths. The Melanoma Program has a network of cooperating clinics. Most patients with a primary skin lesion are first evaluated by a Hopkins dermatologist for biopsy and diagnosis, then referred for further care according to their stage of disease. Patients with early disease that is limited to the skin or has spread to draining lymph nodes are seen by the Department of Surgery. Medical oncologists address more advanced cases. Patients who have failed traditional treatments are offered access to clinical trials. |  |
Topalian points out that the strength of the Melanoma Program “is going to rest on the science that we have available here on campus, which is, in my opinion, unparalleled.”
She has studied the antitumor immune response in melanoma patients for more than 20 years and discovered important information on the development of immune-based treatments for melanoma and other cancers. Here, she’ll continue with her basic research and spend the majority of her time translating scientific discoveries into clinical trials that will be available to Hopkins patients.
Surgeon Charles Balch, a world-renowned expert in the clinical care of melanoma patients and a pioneer in the area of sentinel lymph node biopsy, also is heading up a clinical trials group within the department. Balch recently established that the presence of even microscopic tumor in the draining lymph nodes has a strong influence on a patient’s prognosis. He will be participating in a national, multicenter study to look at what should be done with the information from lymph node biopsies. Will removing the lymph nodes be of sufficient long-term benefit for the patient to outweigh the risks?
Because caring for melanoma patients can be complex, it requires a team management approach. Topalian, Balch and Julie Lange, who is a clinical co-director of the Melanoma Program, make up the surgical oncology group. Others who attend the weekly multidisciplinary conferences on patient management include dermatologists, plastic surgeons, head and neck surgeons, medical and radiation oncologists, radiologists, ophthalmologists, dermatopathologists and surgical pathologists. Physicians with practices at Hopkins’ Green Spring Station and Johns Hopkins Bayview Medical Center also attend these meetings.
“The correct diagnosis is the key to everything in these challenging cases,” says Topalian. “Sometimes you have to do more intensive investigations that involve molecular biology approaches. You may have to go beyond the standard, garden-variety slide staining to get to the bottom of it.”
While practitioners offer excellent patient care, clinical trials look to the future. One is a blood-collection study from patients with metastatic mela-noma to see if a particular protein in the blood correlates with the presence of melanoma. Another trial is evaluating whether a new oral cancer medicine helps chemotherapy work better in patients with advanced disease. There are also studies to evaluate melanoma vaccines and agents that modulate the activity of the antimelanoma immune response. “I do believe that we’re positioned to do great things,” says Topalian.
For more information on the Melanoma Program, go to www.hopkinsmelanoma.org, or call patient coordinator Robin Lewis at 410-614-1022.