Saint John’s Cancer Institute’s melanoma study published in prestigious New England Journal of Medicine

June 07, 2017

Twenty-five years after a groundbreaking discovery at the Saint John’s Cancer Institute regarding the early diagnosis of melanoma, high-level research continues to advance treatment options for the potentially deadly cancer in its earliest stage.

Today, the New England Journal of Medicine published results of the latest study in this ongoing research at the institute, which is affiliated with Providence Saint John’s Health Center in Santa Monica.

The randomized study found no difference in survival rates related to melanoma for patients whose cancer had spread to the lymph nodes and immediately had them removed, or those who underwent regular ultrasound observation to monitor fluid draining from a tumor to the lymph nodes. The study concluded that delaying surgery while continuing observation is an acceptable option, said Lisa Van Kreuningen, director of clinical research operations for the cancer institute.

The advantage of observation over surgery is that surgically removing lymph nodes can cause permanent side effects, including lymphedema, which causes painful swelling, Van Kreuningen said.

The research was funded primarily by a long-term grant from the National Institutes of Health and led by Mark Faries, M.D., a former researcher at the institute. Dr. Faries earned national recognition for his melanoma research. Faries, who left the institute in April, led the melanoma program at the Saint John’s Cancer Institute as well as its fellowship program.

More than 4,000 early-stage melanoma patients from across the globe took part in the study.

Titled “Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma,” the study’s findings are based on research that began in 2004.

The late Donald L. Morton, M.D., who established the institute’s melanoma program, originated a technique for determining the stage of a patient’s melanoma by identifying the sentinel nodes – the first lymph nodes into which a tumor drains.

This revolutionary diagnostic technique helps surgeons determine if a tumor has spread to nearby lymph nodes, one of the most important factors in determining a patient’s prognosis. Continuous monitoring via ultrasound tests may be a better option for patients under treatment for Stage 1 melanoma.

Studies of early stage melanoma continue at the cancer institute, said David Hoon, M.D., a specialist in molecular oncology who assisted in the most recent study.

“It’s very important to diagnose early stage metastasis,” Dr. Hoon said. “You cure people for life. It saves excessive surgery and it saves billions of dollars in treatment.”