Multidisciplinary Care for Malignant Melanoma

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The treatment of patients with metastatic melanoma requires a team approach. The complexities of this disease warrants impute from several specialists to properly deliver care, the panelists agree. Along these lines, however, one specialty that is commonly forgotten are the interventional radiologists, suggests Robert H.I. Andtbacka, MD. Interventional radiologists are getting more involved in the treatment of melanoma through the use of radiofrequency ablation on solitary metastatic lesions, Andtbacka notes.

A team approach is also important when managing side effects, particularly the colitis that can be associated with treatments like ipilimumab, as an example. As a surgeon, Andtbacka is aware of management strategies for this adverse event, such as steroid administration, from participating in multidisciplinary tumor boards. Treating the disease can be more art than science, adds Anna Pavlick, DO. This also extends to recognizing and managing dermatologic, gastrointestinal, and endocrine toxicities.

It is important to emphasize to patients that the management of a side effect may not impact the efficacy of treatment, Omid Hamid, MD, notes. Additionally, having a toxicity does not indicate that a treatment is working. This should be conveyed to patients.

A team approach and proper education is particularly important with the newer immune checkpoint inhibitors, adds Howard L. Kaufman, MD. With these agents, hormone levels should be assessed, requiring a certain level of expertise in endocrinology. In some situations, hypopituitarism can mimic disease progress and warrants assessment at every visit, Hamid suggests.