Melanoma: Standard of Care
Guest: Dr. E. Ramsay Camp – Department of Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. E. Ramsey Camp, Assistant Professor of Surgery in the Division of Surgical Oncology here at MUSC. Dr. Camp, that’s an area in which you specialize in the surgical treatment of people with cancer, is that right?
Dr. E. Ramsay Camp: Correct.
Dr. Linda Austin: And what kinds of cancers do you treat most?
Dr. E. Ramsay Camp: My interest in surgical oncology involves both gastrointestinal malignancies, including pancreatic cancer, colorectal cancer, as well as melanomas and sarcomas.
Dr. Linda Austin: I know you have a special interest in the treatment of melanomas. That’s a kind of cancer people often have a hard time getting good treatment for. So, let’s walk through that. Let’s imagine that a patient has been to their dermatologist. They’ve had a mole removed. And the dermatologist calls them back and says, I’m a little concerned about this. The report came back that it’s a melanoma. What would be the next step for that patient?
Dr. E. Ramsay Camp: Well, that depends on the stage of the melanoma. Early- stage melanomas, thin melanomas, can be addressed by a dermatologist in the outpatient surgical setting, for melanoma in site 2 and early stage 1 melanomas. As we get the results back from the initial biopsy, the depth of the melanoma often determines what we do next.
Dr. Linda Austin: So, the very first thing would be to figure out not just that it is a melanoma, but how big a melanoma, how deep it goes, is that right?
Dr. E. Ramsay Camp: Correct.
Dr. Linda Austin: Okay. And so, hopefully, it would prove to be an early-stage and could be taken off by the dermatologist, and then the patient would be followed after that?
Dr. E. Ramsay Camp: Correct. For early-stage melanomas, the only management is with surgery. That adequately treats melanoma in site 2. Then, in site 2 has a premalignant stage, not yet developed into melanoma and an invasive malignancy.
Dr. Linda Austin: I see. Okay. Now, let’s imagine that this person’s melanoma is not so early, that it actually has spread to other parts of the body. How would someone begin to look for a place to get that treated? How would they choose a doctor, or even find a setting, where they could get their melanoma treated?
Dr. E. Ramsay Camp: I think one of the critical aspects is to recognize centers that take a multidisciplinary approach to patient care. I think as melanoma becomes more advanced, it takes clinicians with expertise in both the surgical management as well as the medical management, which includes considerations for chemotherapy and radiation oncology. So, I think centers where they have focused expertise in that are critical for patients with advanced melanoma. One of the challenges we face is that the options for finding adequate therapies for these patients are currently limited. So, at our institution, we’re actively pursuing cutting-edge clinical trials with standard chemotherapies as well as immune therapies to, hopefully, help these patients.
Dr. Linda Austin: And, of course, we’re so excited, here at MUSC, that we got our National Cancer Institute designation as a Cancer Center. So, you, as a surgical oncologist, would then work with the radiation folks, as well as the oncologists who provide chemotherapy, to help these patients?
Dr. E. Ramsay Camp: Correct. You know, we have a whole team concept here, a program we’re working on, the Comprehensive Melanoma Program, where we take a team viewpoint, where we work together. We collaborate and come up with a unified treatment plan for each individual patient. That team consists of the dermatologist, the surgical oncologist, experts in Head and Neck surgical oncology, who help manage the patients with melanomas of the head and neck. We also have medical oncologists who have an interest in melanoma, as well as radiation oncologists. Other integral members of this team are the radiologists who help us with the staging workup of our patients, as well as the pathologists who review the biopsy and surgical specimens.
Dr. Linda Austin: So, a challenging illness like this, really, does require specialists in different areas, oncologists, surgeons, and so forth, to get the best care for the patient?
Dr. E. Ramsay Camp: Correct. I believe that’s of critical importance.
Dr. Linda Austin: Now, we have a new program here that is lead by Dr. Mike Nishimura; we’ve actually done a podcast on that, studying and investigating immune therapies for melanomas. Can you describe what the program is and what that might offer?
Dr. E. Ramsay Camp: Well, the initial phase of the program will work to develop novel strategies for advanced melanoma patients, using their own lymphocytes genetically engineered to be more aggressive and to fight the melanoma.
Dr. Linda Austin: And, as I understand it, they take the patient’s blood, a sample of blood, take the lymphocytes from the blood, genetically engineer, correct? And then what happens?
Dr. E. Ramsay Camp: And then they replace those cells back into the body to, hopefully, treat the tumor cells, which the T lymphocytes are specifically going to target.
Dr. Linda Austin: I see. So, they kind of rev up the patient’s own immune system to recognize the tumor and fight the tumor cells?
Dr. E. Ramsay Camp: Correct.
Dr. Linda Austin: Very exciting. So, what do you foresee, then, in the coming months and years, in your time here at MUSC? What’s your vision?
Dr. E. Ramsay Camp: Well, I think, initially, our plan is to further develop our multidisciplinary program, focusing on many aspects of melanoma care. One: to make patient care more efficient. Our team approach, where we all work together, is to develop the best care plan at one visit for the patient. Our other goals in this program are to develop screening and preventative strategies, working closely with our dermatologists here. They provide many important parts of the care of the melanoma patient, screening patients, as well as mole mapping, where they image patients who have multiple atypical nevi. This helps us screen patients for the development of future melanomas.
Dr. Linda Austin: When you say words like multiple atypical nevi, that’s second nature for you, but that really translates as many unusual and, maybe, suspicious moles for the patient, which they really need to keep an eye on.
Dr. E. Ramsay Camp: Yes.
Dr. Linda Austin: Prevention is a big piece of it.
Dr. E. Ramsay Camp: Well, we know that patients who have developed a melanoma are eight to ten times more likely to develop a secondary melanoma. So, our patients that we have initially treated for melanoma, we follow long term. Usually, we recommend screening skin evaluations every three months.
Dr. Linda Austin: Dr. Camp, good luck in your work here. We’re so glad to have you with us.
Dr. E. Ramsay Camp: Thank you.
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