Skin cancer: below the surface
Consultant Dermatologist Dr Louise Fearfield with colleague
More than 1,000 people are referred to the Trust each year, which offers a range of surgical treatments, radiotherapy techniques and chemotherapy. Skin diagnostic clinics are held in the Rapid Diagnostic and Assessment Centre on both hospital sites to provide a streamlined service.
“Patients can be seen, photographed and, if necessary, have their lesion biopsied on the same day,” says Dr Louise Fearfield, Consultant Dermatologist (pictured above).
The Royal Marsden is developing a mole mapping system using the latest digital dermoscopy technology to monitor atypical moles. “This technique is especially useful for those at higher risk of malignant melanoma,” says Dr Christopher Harland, Consultant Dermatologist.
“Some people have many moles, and this effectively tracks them for changes. It means melanoma can be detected early, when treatment is most effective, and prevents the removal of harmless moles.”
Surgery and surveillance
Mr Kieran Power, Consultant Plastic and Reconstructive Surgeon, works closely with Royal Marsden dermatologists.
“I see patients with more complex skin cancer that needs reconstruction, and can be on their face,” says Mr Power. "I use a range of techniques, such as local flaps or grafts. The aim is to excise the cancer with an appropriate margin and achieve the best possible functional and aesthetic outcome for patients.”
The Royal Marsden offers sentinel lymph node biopsy (SLNB) for patients with melanoma, and ultrasound surveillance of lymph nodes. Both Mr Power and Mr Myles Smith, Consultant Surgeon, conduct the surgical procedure at Chelsea and Sutton.
“The sentinel nodes are the first place melanoma is likely to spread,” says Mr Power. “And this test, under general anaesthetic, allows us to see any evidence of microscopic spread to the lymph glands.”
Isolated limb perfusion
The Royal Marsden is the only centre in England that offers isolated limb perfusion (ILP) for advanced melanoma affecting the limbs. ILP is given under general anaesthetic and involves treating just the limb with chemotherapy drugs at doses the rest of the body would be unable to withstand.
“As melanoma on the legs and arms spreads, for one in 10 patients, lesions appear in outbursts gradually higher up the limb – known as in-transit disease – before the cancer makes its way commonly to the lymph nodes”, says Mr Andrew Hayes, Consultant Surgeon and Head of the Skin Unit.
“Cutting out or lasering the cancerous lesions is the first treatment option. However, if many lesions appear or they are large – between 1cm and 3cm – we can perform the ILP procedure. It can be very effective at treating this form of cancer, preventing the need for ongoing chemotherapy or the limb to be amputated.”
The Royal Marsden is one of the first centres in London to offer T-VEC immunotherapy for private patients with unresectable advanced melanoma. Immunotherapy harnesses the body’s immune response to target and destroy cancer cells. This pioneering treatment has been developed by researchers and clinicians at The Royal Marsden and The Institute of Cancer Research, led by Professor Kevin Harrington.
Mr Andrew Hayes
Consultant Surgeon and Surgical Oncologist
Mr Hayes specialises in soft-tissue sarcoma and advanced melanoma. He leads the isolated limb perfusion programme, which provides a national service for regional chemotherapy for patients with advanced limb malignancy.