Dr. Mecker Moller is a surgical oncologist at Sylvester Comprehensive Cancer Center, part of University of Miami Health System. For more information on the treatment of melanoma at Sylvester or to make an appointment, call 305-243-1000 or visit the University of Miami's health news blog.
TVEC INJECTIONS IMPROVE OUTCOMES
Alicia Yutsy was vacationing with her family four years ago when she noticed a deep scrape on the bottom of her foot that did not heal. A biopsy revealed that the wound was actually acral lentiginous melanoma, which occurs either on the palms of the hands or the soles of the feet and is often treatable with surgery.
Dr. Mecker Moller, a surgical oncologist at Sylvester Comprehensive Cancer Center, performed several surgeries to resect the melanoma and reconstruct the foot, as well as remove lymph nodes in the groin where the cancer had metastasized. “After the surgeries thank god there was no need for any further treatment,” says Alicia.
But in late 2018, the melanoma returned in the form of more than a dozen lesions on Alicia’s leg. Dr. Moller refers to this as transmitted metastasis, a skin metastasis that is located just beneath the surface of the skin, making it difficult to treat. “Melanoma is a wild animal, it’s unpredictable sometimes,” says Dr. Moller.
When the lesions did not respond to chemotherapy alone, Dr. Moller took a novel approach, using a genetically-modified herpes virus designed to work with the body’s immune system to destroy cancer cells. The localized treatment, called TVEC (talimogene laherparepvec), was fast tracked for approval by the FDA in 2015 due to an encouraging response rate in melanoma patients.
“It is not chemotherapy, is not a vaccine what it does is basically stimulate your own immune system to attack the melanoma cells,” says Dr. Moller.
TVEC is prepped about an hour before the patient arrives, then injected directly into the cancerous lesions. It has shown promise for patients with advanced melanoma who are not treatable with surgery. Alicia receives regular injections alongside her chemotherapy regimen.
Boosted by the TVEC injections, the lesions began to disappear. According to Dr. Moller, more than half of Alicia’s original lesions are gone as a result of the treatment. “When we started with the injections, that’s when we started seeing positive results,” says Alicia. “I was so excited. I said, ’Oh my god, this is working.’”
“This is a great alternative that we have now for melanoma patients that we didn’t have just a few years ago,” says Dr. Moller. “It’s exciting because we can save the patient’s extremity, we can provide quality of life to the patient, even with advanced disease.”
The melanoma team at Sylvester is prepared to treat even the most complex cases, says Dr. Moller. “We have a gem here in South Florida because we have an excellent melanoma program. We treat non-small cell carcinomas, as well as other skin cancers and we are the only Center of Excellence for melanoma in the region.”
For Alicia, it’s the personal touch that sets Sylvester apart. “They always make me feel like I am the only patient they have that day,” she says.
Early detection is an important aspect of successfully treating melanoma, says Dr. Moller. Patients should be aware of moles that are changing in size, color or shape. “Any lesion that is new and is growing needs to be brought to the attention of a primary care doctor or a dermatologist.”
FOCUSING ON YOU
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