Inderjit Mehmi, MD: Diagnostic Challenges of Mucosal Melanoma

In this interview segment with HCPLive, Inderjit Mehmi, MD, spoke further on the rare but aggressive disease mucosal melanoma, a cancer of the mucosal membranes with a poor prognosis and little data around treatment.

Inderjit serves as a Medical Oncologist at Cedars-Sinai’s Angeles Clinic and Research Institute in West Los Angeles.

“Most of the treatment algorithms that are currently available for melanoma, they're essentially borrowed from cutaneous melanoma,” Inderjit said. “And some of the larger clinical trials that have happened for melanoma in general included some of the mucosal melanoma patients as well.”

He explained that based on this, those who work on treating the condition treat advanced mucosal melanoma with immunotherapies, with either single agent, checkpoint inhibitors, anti PD-1 blocking antibodies, or a combination with CTLA-4 blocking antibodies.

“But there is a small amount of data available that if we combine PD-1 blocking antibodies with some of the broad spectrum VEGF inhibitors, we may be able to get a little bit of better response rate,” he said.

Inderjit noted that it may be a reasonable approach, but added that the VEGF inhibitors are relatively difficult to tolerate. As a result, there is heavy reliance on pembrolizumab or nivolumab, or combination of nivolumab and ipilimumab.

“For advanced therapies, for mucosal melanoma and for early disease that may be limited to some organs alone, surgery remains an option for treatment,” he said. “At that time, we'll use postoperative radiation to locally control the disease. But again, you know, it's such a relatively rare disease that having large numbers within clinical trials to establish some of the treatment guidelines. It's been difficult.”

Inderjit later went on to describe steps to be taken to prevent and watch out for the condition, although he restatee the difficulty in the process.

“I think if it’s, for example, the gynecological area type of melanoma, then any kind of symptoms, any abnormal bleeding in females, that should be checked by a gynecologist and they should be making sure that there isn't any issues in mucosal melanoma that sort especially beyond the ages of menstruating.”

He noted that there is not yet a reliable screening method as a means of discriminating between this type and another melanoma type.

To learn more about Mehmi’s discussion, view the full interview segment above.