What does progression mean for Melanoma and what happens next

Understanding Progression in Melanoma

What Does "Progression" Mean?

Progression means your melanoma is growing or spreading despite treatment. It indicates that the cancer cells are not responding as hoped to your current therapy. This can happen in different ways:

• Local progression: The cancer grows at or near the original tumor site
• Regional progression: Cancer spreads to nearby lymph nodes or appears as new tumors in the skin between the original site and regional lymph nodes (called satellite or in-transit recurrence)
• Distant progression: Cancer spreads to organs or distant parts of the body (metastatic disease)

According to the NCCN Guidelines for Patients: Melanoma, progression is an important signal that your treatment plan needs to be reassessed and adjusted.

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What Happens Next After Progression?

Step 1: Evaluation and Testing

Your care team will typically:

• Perform imaging and biopsies to confirm progression and understand exactly where the cancer has spread
• Test for specific mutations (like BRAF V600 mutations) if not already done—these genetic changes in cancer cells help determine which treatments might work best
• Assess your overall health to determine what treatments you can tolerate

Step 2: Treatment Options Based on Type of Progression

For Local/Regional Progression (Resectable Disease):

According to NCCN Guidelines, your doctor may recommend:

• Neoadjuvant systemic therapy (treatment given before surgery to shrink the tumor)
• Surgery to remove all visible disease with clear margins
• T-VEC (talimogene laherparepvec) - an intralesional therapy that uses a modified virus to kill cancer cells directly in the tumor
• Systemic therapy (drugs that travel throughout your body)

For Unresectable/Borderline Resectable Disease (cancer that cannot be completely removed by surgery):

The NCCN Guidelines indicate systemic therapy is the preferred initial treatment, which includes:

• Immunotherapy checkpoint inhibitors like:

  • Nivolumab (Opdivo)
  • Pembrolizumab (Keytruda)
  • Ipilimumab (used in certain situations)

• Targeted therapy (if you have a BRAF V600 mutation):

  • Dabrafenib/trametinib combination

• Other local options:

  • Radiation therapy
  • Intralesional T-VEC injections
  • Regional chemotherapy (isolated limb infusion/perfusion for melanoma in arms or legs)

Step 3: Response Assessment

After starting new treatment, your care team will:

• Monitor you with imaging and physical exams
• Determine if the cancer is responding
• Adjust treatment if needed

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Important Questions to Ask Your Oncologist

1. What type of progression do I have? (local, regional, or distant?)
2. What testing will you do to guide my next treatment? (especially BRAF mutation testing)
3. Which treatment approach do you recommend for my specific situation, and why?
4. What are the expected benefits and side effects of this treatment?
5. How will we measure whether the treatment is working?
6. Are there clinical trials available for my type of progression?
7. What is the timeline for reassessing my response to treatment?

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Key Takeaway

Progression is challenging news, but it's not the end of your treatment options. The NCCN Guidelines emphasize that melanoma has multiple effective treatments available, even when cancer progresses. Your oncologist will use information about your specific type of progression and any genetic mutations to select the most appropriate next therapy.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.