• A complete review of the patient’s medical history and risk factors (UV rays, skin phototype, family history, sunburns, moles) [1] [2]; a review of symptoms and signs prior to presentation (ABCD rule) [3]; a review of diagnostic criteria and complementary tests (dermatoscopy, biopsy, ultrasound,PET/CT) [4] [5] [6]; a review and analysis of the patient’s pathology report relating to AJCC classification with TNM staging ("Tumor Node Metastasis") [7] [8] based on the latest guidelines and changes, as wsll as prognostic factors (sentinel node, Breslow index, Clark level, mitotic index, tumor locasion, pattern of growth, histological type, age and sex) [9].
• Referrals to support groups that may be of assistance in handling the emotional impact that cancer has on the patient and the patient's family.
• Referrals to melanoma-specific organizations that may be of assistance in addressing insurance issues or employment termination issues (because of diagnosis or disclosure of metastatic disease).
• Review of the nature/amelioration of specific side effects from chemotherapy (such as nausea and neuropathy) as well as from other treatment modalities.
• Discussion of the interaction of diet and cancer chemotherapy drugs based on recent studies.
• Review of ipilimumab (Bristol Myers Squibb'sYervoy), a monoclonal antibody that binds to CTLA-4 and vemurafenib (Roche/Genentech's Zelboraf) which blocks mutated BRAFV600, as single agents and in combination in the Phase I/II clinical trial led by Sloan-Kettering's Jedd Wolchok, MD, Dana-Farber Cancer Institute's Stephen Hodi, MD and UCLA's Antonio Ribas, MD.
• Delineation of the symptoms about which the patient should alert his/her oncologist.
• Discussion of relevant imaging technology.
• Discussion of pain management issues and treatment options that can be addressed with the patient's medical team.
• Explanation of the recommendations given or not given by the patient's physicians; assistance in answering the patient's questions which remain either after or between appointments with the medical team.
• Review of the relevant radiotherapy/interventional radiology options which the patient contact, in turn, may discuss with his/her medical team.
• Discussion of the relevance of the patient's specific immunohistochemistry and cytogenetic results to available clinical trials so that the patient may explore all options with his/her medical team.
• Analysis of relevant clinical trials options as well as the nature and purpose of clinical trials using Remission Coach®.
• Review of relevant melanoma-specific drugs in the anticancer pipeline.
• Review of ipilimumab (Bristol Myers Squibb'sYervoy), a monoclonal antibody that binds to CTLA-4 and vemurafenib (Roche/Genentech's Zelboraf) which blocks mutated BRAFV600, as single agents and in combination in the Phase I/II clinical trial led by Sloan-Kettering's Jedd Wolchok, MD, Dana-Farber Cancer Institute's Stephen Hodi, MD and UCLA's Antonio Ribas, MD.
• Review of all relevant and complementary and alternative medicine ("CAM") avenues.
• Review of the merits of filing a "Single Patient IND for Compassionate or Emergency Use" for a specific experimental cancer drug, if relevant to the patient’s situation.
• Exploration of options that might reduce travel costs for the patient contact, such as Corporate Angels Network, as well as ICAN supporters who have volunteered to host a clinical trials patient in a particular city.

---

[1] Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence. Bastuji-Garin S, Diepgen TL. Br J Dermatol. 2002 Apr;146 Suppl 61:24-30

[2] Skin checks. Sinclair R. Aust Fam Physician. 2012 Jul;41(7):464-9.

[3] Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Dummer R, Hauschild A, Guggenheim M, Jost L, Pentheroudakis G; ESMO Guidelines Working Group. Ann Oncol. 2010 May;21 Suppl 5:v194-7.

[4] Imaging in cutaneous melanoma. Ho Shon IA, Chung DK, Saw RP, Thompson JF. Nucl Med Commun. 2008 Oct;29(10):847-76.

[5] Diagnostic techniques for primary cutaneous melanoma. Lien MH, Sondak VK. G Ital Dermatol Venereol. 2009 Apr;144(2):187-94.

[6] Dermatoscopy for melanoma and pigmented lesions. Rao BK, Ahn CS. Dermatol Clin. 2012 Jul;30(3):413-34.

[7] Malignant melanoma. Ortega Candil A, Rodríguez Rey C, Carreras Delgado JL. ISRN Dermatol. 2012;2012:308279. Epub 2012 December 4.

[8] Histopathological diagnostics of malignant melanoma in accordance with the recent AJCC classification 2009: Review of the literature and recommendations for general practice. Garbe C, Eigentler TK, Bauer J, Blödorn-Schlicht N, Fend F, Hantschke M, Kurschat P, Kutzner H, Metze D, Pressler H, Reusch M,Röcken M, Stadler R, Tronnier M, Yazdi A, Metzler G. J Dtsch Dermatol Ges. 2011 Sep;9(9):690-9.

[9] Role of Nuclear Medicine in the Management of Cutaneous Malignant Melanoma. Belhocine TZ, Scott AM, Even-Sapir E, Urbain JL, Essner R. Journal of Nuclear Medicine. 2006;47(6):957–967.

ICAN is currently working on The Mary Ann Granger-Alderson Clinical Trials Advocacy Program. We are working to put together a Family and Friends Advisory Council for the The Mary Ann Granger-Alderson Clinical Trials Advocacy Program. If interested, please email us at Mary Ann.Granger-Alderson.Program@askican.org.

If you would like to become involved as a donor and supporter or a member of our Cancer Research Literature team as a Research Team Leader (medical school students, physicians, nurses, and post-docs only please), you may reach us at Mary Ann.Granger-Alderson.Program@askican.org.

Federal Tax I.D.: EIN 86-0818253 | WA Charities: 37195