Skin cancer

Skin cancers are characterized by an uncontrolled and abnormal multiplication of skin tissue (skin tissue). There are two main categories:

• carcinomas (about 90% of cases)
• melanomas (about 10% of cases)

Other types of skin cancers also exist, such as Merkel cell carcinoma, Kaposi sarcoma, and cutaneous lymphoma, but they are much less common, accounting for less than 1% of skin cancers.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

In melanoma, we look in particular for:

• The T, which describes the size and extent of the tumor
• The N, which indicates whether the cancer has spread to nearby lymph nodes
• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

The Breslow Index is a measure of tumor thickness that is used to assess the severity of melanoma. The Breslow Index is an important element in the classification of melanoma according to the TNM classification system. More specifically, it is used to determine category T, which measures the size and extension of the tumor.

This information can be found on the pathologic report or a consultation report.

NB: On the platform Klineo, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

TNM classification table for melanomas

Primary tumour (T)

Lymph nodes (N)

Distant metastases (M)

At the localized stadium : surgery is the main treatment, followed by radiation therapy. Adjuvant chemotherapy may be combined with surgery and radiation therapy.

In the metastatic stage : Immunotherapy treatment may be proposed (anti-PDL1). The alternative to this treatment may be chemotherapy with carboplatin-etoposide.

Surgery : Surgery is the main treatment for Merkel carcinomas. Different surgical techniques can be used depending on size, location and medical history (surgical excision, Mohs surgery, lymph node dissection...)

Radiotherapy : Radiotherapy consists in using radiation (we also say rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers. In the case of Merkel carcinomas, radiation therapy may also be prescribed after surgery, this is called adjuvant therapy.

Chemotherapy : This is a treatment that uses powerful drugs to destroy cancer cells by preventing them from multiplying or spreading in the body. In the case of Merkel carcinomas, the most common chemotherapies are:

• Cisplatin (Platinol AQ) or carboplatin (Paraplatin, Paraplatin AQ), which can be combined with etoposide (Vepesid, VP-16). Only topotecan (Hycamtin) may be used in some cases.

Immunotherapy: Immunotherapy is a treatment that aims to stimulate the body’s immune defenses against cancer cells. In the case of Merkel carcinomas, anti-PDL1 antibodies, such as Avelumab (BAVENCIO), may be used in some cases.

There are other treatments available via clinical trials. With Klineo, you can find the clinical trials that suit your situation. For this, it is important to enter the treatments received in order to find relevant clinical trials. This information can be found in the recent consultation report.