Melanoma Diagnosis and Treatment

One of OHSU's Knight Cancer Institute Dermatologists inspecting a patients arm for melanomas.

Dr. Sancy Leachman (right) heads OHSU's Department of Dermatology and is director of the Melanoma Research Program at the Knight Cancer Institute. She focuses on prevention and early detection of melanoma, particularly in families at higher risk.

Our team includes some of the nation’s leading experts on diagnosing and treating melanoma. Our dermatologists, surgeons, oncologists (cancer doctors), radiologists and nurses work together to give you the most advanced care possible.

  • Our experts develop an individual treatment plan for you based on your needs and specific cancer.
  • Our physician-nurse practitioner team has a combined 45 years of experience in melanoma screening. Patients with new lesions benefit from quick diagnosis and treatment.
  • Our team meets three times a month, combining expertise to recommend the best treatment options.
  • You'll have access to pioneering research and clinical trials exploring the latest treatments.
  • We are one of the few U.S. hospitals with the expertise and technology to offer Mohs surgery for a small portion of melanomas.

Melanoma screening

We have the advanced expertise and tools to catch suspicious lesions early, when melanoma is most curable. You'll find:

  • Full-body exams: These are typically done once a year. Patients at high risk of melanoma have them more often.
  • Full-body photography: This tracks changes over time. Our high-resolution DermSpectraTM system uses nine cameras and a private booth.
  • Mole Mapper, a free OHSU smartphone app that helps you track moles between visits.

Dr. Matthew Taylor, a Medical Oncologist for OHSU's Knight Cancer Institute.

ABOVE: As a medical oncologist, Dr. Matthew Taylor is an expert in treating
 cancer with chemotherapy and other medications. BELOW RIGHT: Dr. John Vetto

is a cancer surgeon who leads the Department of Surgery's skin cancer program.


Melanoma diagnosis

If you have a mole or skin area that looks abnormal, your doctor may run tests such as:

Skin exam: Your doctor will examine your skin for moles, lesions or areas that look abnormal. Many dermatologists use a device called a dermatoscope, which has a light and magnifier to show skin more clearly. Your dermatologist might take photos to track changes over time.

Biopsy: If a mole looks suspicious, your doctor may remove a small amount of tissue. A type of doctor called a pathologist will look at the tissue under a microscope to check for cancer cells. For some minor cases, the entire tumor is removed as part of the biopsy, and only monitoring is needed otherwise.

Sentinel lymph node biopsy: If a deeper melanoma is found, your doctor will check whether cancer has spread to your lymph nodes. Your doctor will remove the "sentinel" lymph node, the node where cancer is most likely to spread first. That node and possibly others will be checked under a microscope for cancer cells.

Further lymph node biopsies: If no cancer is found in the sentinel lymph node, it is highly unlikely the melanoma has spread. If cancer cells are found, other lymph nodes may be removed and examined.

Melanoma treatments

Your treatment will depend on the depth of the melanoma and how advanced it is. In mild cases, surgical removal may be all that’s needed.

Melanoma surgery

  • A Knight Cancer Institute surgeon speaking with a patient just before performing a procedure.In-office excision: Many early-stage melanomas can be removed during an office appointment.
  • Wide local excision: For slightly deeper cancers, margins around the cancer are wider to ensure that all the cancer is removed.
  • Mohs surgery: This is most often used  for other skin cancers. But OHSU's advanced imaging technology and expertise make it an option for certain melanomas. The surgeon removes a layer of skin and tissue at and around the tumor and examines it under a microscope. The process is repeated until no cancer cells are seen.
  • Lymph node dissection: If a biopsy shows cancer in a sentinel lymph node, your doctor may recommend removing nearby lymph nodes to keep the cancer from spreading.

Targeted therapies

These medications target the genetic parts of melanoma cells that help the cancer grow. OHSU Knight Diagnostic Laboratories offer state-of-the-art testing to identify targeted therapies. Examples:

BRAF inhibitors: About half of people with melanoma have tumor mutations in what is called the BRAF gene. These changes cause the gene to make an abnormal protein that helps melanoma cells grow rapidly. Medications (given as pills) called BRAF inhibitors shut down the abnormal protein.

MEK inhibitors: Something called the MEK gene works with the BRAF gene, so MEK inhibitors (also in pill form) can work in the same way.

Immunotherapies

Scientists and doctors have made gains in using medications to help your immune system destroy cancer cells. These medications are given intravenously. Learn more about immunotherapy at the Knight Cancer Institute.

Radiation therapy

Radiation in the form of high-energy rays or sometimes particles can kill cancer cells. Radiation may be used after surgery, especially if cancer has invaded lymph nodes. Radiation therapy is also used to treat melanoma that has come back after surgery and to treat organs affected by the spread of melanoma.

Chemotherapy

Chemotherapy may be recommended for people with melanoma that has spread to distant parts of the body. Certain chemotherapy medications can shrink these melanomas, though the cancer often starts growing again within several months.

An OHSU Knight Cancer Institute doctor comforting patient during a checkup.

Susan Tofte, a family nurse practitioner, gives patients expert
 melanoma screening, treatment, education and counseling.

Additional services

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