Melanoma is the most aggressive skin malignancy. Ichilov runs a dedicated Melanoma Centre programme staffed by dermato-oncologists, surgeons, immunotherapists and radiation oncologists.
Diagnostics
- High-resolution dermatoscopy and digital mole monitoring;
- Excisional biopsy with morphologic assessment by Breslow and Clark;
- Molecular panel: BRAF, NRAS, c-KIT, PD-L1;
- Whole-body PET-CT if metastatic disease is suspected;
- Brain MRI — mandatory at stage IV.
Immunotherapy — the first-line standard
According to the institute, with modern immunotherapy, durable remission is achieved in 84% of patients with metastatic melanoma expressing PD-L1. The agents used are:
- Pembrolizumab (Keytruda) and Nivolumab (Opdivo) — anti-PD-1;
- Ipilimumab (Yervoy) — anti-CTLA-4 (in combination);
- Relatlimab + nivolumab — anti-LAG-3 / anti-PD-1 combination.
Targeted therapy (BRAF mutations)
Around 50% of melanoma patients carry the BRAF V600 mutation. Combination regimens include:
- Dabrafenib + trametinib;
- Encorafenib + binimetinib;
- Vemurafenib + cobimetinib.
Surgery and adjuvant treatment
- Wide excision of the primary tumour with sentinel lymph node biopsy;
- Complete lymph node dissection if the sentinel node is involved;
- Adjuvant immunotherapy to prevent recurrence (1 year);
- Isolated limb chemoperfusion for local recurrence.
Brain metastasis radiosurgery
Gamma Knife and CyberKnife are used — single-session stereotactic radiotherapy controls multiple metastases without open surgery.
Prognosis and follow-up
Five-year survival is over 90% at early stages (Ia–IIa). At stage III with adjuvant immunotherapy — 60–70%. At stage IV with response to immunotherapy — up to 50–60%. Follow-up is recommended every 3–6 months for the first 5 years after treatment.