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Jason Wellen, MD

Jason Wellen, MD, specializes in kidney and pancreas transplant surgery. He says the teamwork involved in making just one transplant happen was one of the factors that attracted him to his specialty.

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GI Problems in Infants

My 5-week-old baby is spitting up a lot. Should I be concerned?

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Sudden Death in Young Athletes

Sudden death in young athletes is often caused by a hereditary disease named HCM, often missed by physicians not attuned to its subtle diagnostic clues.

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New Melanoma Treatments on the Horizon

Your dermatologist just diagnosed that dark, irregular shaped spot on your arm as melanoma – an aggressive form of skin cancer that often occurs in sun-exposed areas of the body. However, it can happen on any surface, including the palms of the hands and soles of the feet.

Because melanoma is a quick growing form of skin cancer, immediate surgery is the first step in treatment. The risk of a melanoma spreading to other parts of the body is directly related to its depth of growth, which is assessed from the biopsy by a pathologist.

Ryan Fields, MD, a Washington University cancer surgeon explains, “Treatment for a melanoma less than 0.75mm in thickness, without any other associated adverse features, is a wide excision alone (cutting out). For melanomas greater than 0.75 mm in thickness or for thin melanomas with associated adverse features, wide excision of the melanoma is performed along with a sentinel lymph node biopsy (SLNB).

The SLNB procedure involves injecting a tracer compound around the melanoma that identifies one to two lymph nodes where the melanoma would most likely spread. This allows the surgeon to make a small, limited incision to remove these lymph nodes, which are then analyzed by a pathologist. A wide excision and SLNB procedure are usually done as an outpatient procedure.

When a melanoma is excised and the SLNB is negative, the prognosis is excellent. Close follow-up is usually all that is required. When a melanoma is excised and the SLNB is positive, it is generally recommended for patients to have a complete lymph node dissection to remove the rest of the lymph nodes in the area of the sentinel lymph node. This procedure usually involves a one to three day stay in the hospital. The goal is to remove any further lymph nodes that are at high-risk for containing melanoma, both for diagnostic/prognostic and therapeutic purposes.

Dr. Fields is very encouraged about the rapidly evolving treatments now available for melanoma that has spread to the lymph nodes. He says, “In the past two years, and for the first time in the history of treating melanoma, physicians now have two medications that have been shown to improve survival in patients with melanoma that has spread throughout the body.

The use of these medications after adequate surgery for lymph node-positive melanoma is being evaluated in several ongoing clinical trials at Washington University School of Medicine.”

If you or someone you know has been diagnosed with melanoma, it is important to see a surgeon WITHOUT DELAY. For a consultation with Dr. Fields, please call 314-286-1694.

Patients are seen at:

Center for Advanced Medicine
GI Center
4921 Parkview Place, 8th Floor, Suite C
St. Louis, MO 63110

Barnes-Jewish West County Hospital
Siteman Cancer Center
Medical Building Two
10 Barnes West Drive, Suite 100
Creve Coeur, MO 63141

Ryan Fields, MD

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New Melanoma Treatments on the Horizon

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