Wir überwinden Grenzen

(07.03.2016) Pensioner Markus Maier* feels very well for his age of mid-60s and has no unusual complaints. Only one spot on his back worries him. Although he can't see it directly, he discovers fine traces of blood on the shower towel after drying off. When he consults his dermatologist, he receives an extremely worrying diagnosis: malignant melanoma, also known as black skin cancer.

"If black skin cancer is detected very early, it can usually be completely removed and cured by surgery. However, if the melanoma has already penetrated into deeper layers of the skin, the prognosis can deteriorate significantly," says Dr. Frank Meiß, Acting Senior Consultant at the Department of Dermatology and Venereology at the Freiburg University Medical Center. Until a few years ago, the average survival time for patients with metastatic malignant melanoma was nine to twelve months.

The first and most important treatment is professional surgical removal of the tumor. Dr. Meiß and his team cut out the tumor and measure the thickness of the tumor. "The deeper a malignant melanoma has grown into the skin, the greater the risk that the cancer can form or has already formed metastases," explains Dr. Meiß. In Markus Maier's case, the cancer was already more than one centimeter thick at the time of diagnosis. After the operation, no further tumor cells could initially be detected. But after two months, the patient complains of increasingly severe abdominal pain. In the computer tomogram, the doctors at Freiburg University Hospital see that metastases have developed in the liver, spleen and bones and are growing very quickly. The cancerous tissue is examined using molecular biology. "The patient's cancer cells had a genetic mutation that makes the cells particularly aggressive, the so-called BRAF mutation," says Dr. Meiß. Almost every second patient with malignant melanoma has such a mutation.

However, it was precisely for these patients that a new therapy was established a few years ago. The active substance inhibits the signaling pathway for growth and proliferation in the cancer cells, which ultimately leads to the death of the cells. Healthy cells, on the other hand, are less affected. Markus Maier also responds very well to the therapy: "After just two weeks, the patient's tumor-related blood values were almost normal and the abdominal pain had also subsided," says Dr. Meiß.

However, after six months, the cancer cells became resistant to the drug. "Unfortunately, this is a normal development," says Dr. Meiß. The doctors are now using a completely new therapy in which the patient's immune system is induced to fight the cancer. Markus Maier actually responds very well to this immuno-oncology treatment. In combination with radiotherapy of individual metastases, the cancer can be pushed back again.

Two years after the diagnosis, the disease progresses again. But once again the doctors have a new type of therapy, again immunotherapy. And again the patient responds very well. "We can still only cure advanced black skin cancer in very few cases. But this patient has benefited step by step from innovative therapies and is now - years after his diagnosis - living life to the full despite his illness," says Dr. Meiß.

And even after this therapy, the doctors are not at the end of their options. "The therapy options have expanded significantly in recent years, so that we can still treat patients today for whom we would not have had the option in the past," emphasizes Dr. Meiß.

* Name changed by the editors