Skin cancer

Melanoma is the fourth most common type of cancer in Switzerland. Every year, around 33 out of 100,000 people in Switzerland are newly diagnosed with this form of skin cancer, which amounts to a total of around 3,000 new cases per year. The number of melanoma cases is also rising steadily worldwide.

In over 80% of cases, melanoma can be successfully treated with surgery. However, in around 15% of those affected, the tumour can form metastases in other organs, leading to potentially life-threatening situations.

Cancer cells spread when they enter the lymph nodes or internal organs via the lymphatic or blood vessels and form new tumours there. The risk of such spread depends primarily on the thickness of the melanoma: the thicker the melanoma (measured by the depth of penetration), the more likely it is to metastasise. Early treatment of melanoma increases the chances of a cure, as the tumour is then usually smaller and less deep, which improves the chances of survival.

The primary cause for the development of melanoma is UV radiation, to which people are exposed both through direct sunlight and by visiting sunbeds. There is an increased risk of melanoma for people who:

● have more than 100 moles or liver spots on their skin or have a light skin type (type I-II) = reddish-blonde hair, blue eyes or freckles

● have a family history of melanoma,

● have a weakened immune defence, for example after an organ transplant or due to a disease such as HIV

● have previously been diagnosed with melanoma

● have suffered severe sunburns (especially as a child or adolescent)

The treatment of melanoma depends primarily on the depth of penetration of the tumour.

• In most cases, thin melanomas without metastases can be cured by surgery.
• However, if the melanoma has already penetrated deeper into the skin or small foci of melanoma have been discovered in the lymph nodes, it is categorised as a high-risk melanoma. Although such melanomas have not yet metastasised to distant organs, they carry an increased risk of doing so.
• If the melanoma has already spread to other organs, it is referred to as metastasised melanoma.

In patients with high-risk melanomas, where the tumour has been completely removed, there is still a certain risk of the melanoma recurring. In such cases, the aim of therapy is to achieve a long-term cure through preventive measures, which is known as adjuvant therapy.

For patients with metastases in the organs, a complete cure is no longer possible in many cases. At this stage, therapy is focussed on slowing down the progression of the disease and improving quality of life. Even at this advanced stage, the disease can often be stabilised for years. This approach is known as palliative therapy.

Neoadjuvant therapy
If there is only one (or a few) surgically removable metastases, immunotherapy can be carried out prior to surgery. This procedure provides information on the long-term outcome and improves the chance of cure. In this case, careful co-operation between dermatologists, surgeons and pathologists is important.

The mainstays of melanoma treatment are surgical procedures, drug therapies and radiotherapy.

Surgery
A newly discovered melanoma must be completely removed immediately. Depending on the depth of penetration of the tumour into the skin, different safety margins are required. A sentinel lymph node biopsy is also recommended for certain tumour thicknesses.

Drug therapy
The drug treatment of melanoma has made significant progress in recent years. Effective drugs are now available.

Recent findings have shown that drug therapies can also be used preventively. Both immunotherapeutics and kinase inhibitors are used for this purpose. The duration of preventive therapy is usually one year.

Radiotherapy
Radiotherapy can be an effective treatment option for some tumours. Early stages of melanoma or superficial skin metastases can be treated in dermatology with marginal radiation.

In radiation oncology, higher-energy beams are used to target inaccessible parts of melanoma, such as bone or brain metastases. This method is known as stereotactic radiotherapy.

Immunotherapy
This modern form of therapy aims to activate the patient's own immune cells so that they can specifically fight the cancer cells. Various active substances are also used in combination as required.

Around 40 % of patients achieve a lasting effect with this form of therapy. The combination of several immunotherapies is increasingly being used to increase effectiveness.

Targeted therapy with kinase inhibitors
This therapy attacks specific genetic changes in the tumour in order to stop its growth or cause the tumour to shrink completely. The prerequisite for the use of these drugs is the presence of certain genetic mutations, which are examined in advance in a specialised laboratory.

Injection with TVEC
A specially modified herpes virus is injected directly into the tumour. The virus is modified in such a way that it kills tumour cells directly and at the same time attracts the body's own defence cells. This means that tumour metastases that have not been treated directly can also be affected.

Chemotherapy
Chemotherapy uses cytotoxins to combat the tumour. Today, chemotherapy is often no longer considered the first choice for melanoma, although it is still used in certain cases.

Regular follow-up checks with a dermatologist are essential for melanoma patients in order to determine at an early stage whether metastases have formed or a new melanoma has appeared.

Depending on the severity of the disease, your doctor will determine the appropriate period for the check-ups and decide which additional examinations, such as ultrasound, X-rays or laboratory tests, are required.

Personalised melanoma treatment
There is no universal treatment for melanoma. That is why we develop a customised treatment concept for every patient. Our comprehensive range of services includes all treatment options for melanoma. We have our own surgical department, a day clinic for infusion treatments and TVEC treatments.

Comprehensive care
Our range of services covers the entire spectrum from tumour screening and diagnosis to aftercare and treatment of metastatic melanoma. Our facilities also include a specialised ward.

Tumour prevention and early detection
Our aim is to detect skin cancer at the earliest possible and most treatable stages. Our services include dermoscopy, computer-aided follow-up, whole-body photography and confocal microscopy.

Tumour diagnostics and treatment
We use the latest imaging techniques and work closely with our colleagues in radiology and nuclear medicine. Tissue samples, such as skin and lymph node samples, are analysed according to the latest standards.

Sentinel lymph node biopsy
The histological examination of the sentinel lymph node is carried out professionally by us. Firstly, a second examination of the original melanoma is carried out. The sentinel operation is performed by experienced surgeons at the same time as the re-excision so as not to impair the lymphatic drainage and to identify the correct lymph node. The fine tissue analysis of the sentinel lymph node is then compared with the tissue of the primary melanoma.

Tumour board
Our skin tumour board takes place once a week, bringing together all specialists involved in melanoma - including dermatologists, ENT specialists, plastic surgeons, neurosurgeons, oncologists and radiation oncologists. Other specialist disciplines are also consulted if necessary. This enables complex problems to be discussed quickly and effectively and treatment to be provided in accordance with the latest international standards.