Melanoma treatment in Israel

Professor Michal LotemHead of the Melanoma and Cancer Immunotherapy Center

The Hadassah Clinic main specialists in immunotherapy for metastatic melanoma, including the use of the TIL protocol, are Professor Michal Lotem, head of the Melanoma Treatment Center, and Dr. Yonatan Cohen, a renowned oncologist and researcher.

Since 2002, Professor Lotem’s unique vaccine has helped more than 200 patients with stage 3 and 4 metastatic melanoma. This method is based on adaptive cell therapy (ACT), that is, using the patient’s own immune T-cells. Professor Lotem completed a two-year fellowship at the National Institute of Oncology in Bethesda, USA, under the supervision of renowned immunologist Professor Stephen A. Rosenberg, the founder of TIL-therapy, the vaccine was the result of joint research as well. Therefore, it is not surprising that today the Hadassah Clinic uses both ACT and TIL with particular efficacy for the treatment of melanoma.

At the Hadassah Clinic, the diagnostic process for melanoma typically begins with a thorough physical examination and a review of the patient’s medical history.

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Two case histories

One of the most sensational cases is the story of lawyer Stuart Greenberg from the United States. In 2012 he was diagnosed with melanoma of the 4th degree with metastases in the stomach. American luminaries refused to treat such a neglected case, they predicted Stuart had 3 months to live. The American patient was treated by Professor Lotem, and the melanoma disappeared. A year and a half later, the 2 videos were filmed, in which Greenberg says he feels great. And in 2016, he performed at a gala in Atlanta celebrating the 100th anniversary of the Hadassah Clinic and also felt great. According to Stewart, U.S. medical professionals still can’t believe he’s alive.

Another famous case is the story of Hannah Rapaport, an Israeli woman, a professor at the Biotechnology Department of Ben-Gurion University. In 2002, she was diagnosed with multiple malignant melanoma and her chances of recovery were estimated at only 5%. Hannah and her husband traveled all over the world, visiting many well-known clinics, but found salvation only at the Hadassah Clinic where Hannah was treated by Prof. Lotem. Hannah continues to do research and teach, which is easy to see by visiting the university’s website.

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Melanoma diagnostics at the Hadassah Clinic

Early detection is critical to the successful treatment of melanoma. The diagnostic process for melanoma at the Hadassah Clinic is designed to be thorough and comprehensive, allowing for the accurate diagnosis and staging of the cancer so that the most appropriate treatment plan can be developed.

The diagnostic process for melanoma at the Hadassah Clinic typically begins with a physical exam and a review of the patient’s medical history. The doctor may also perform a biopsy.

If melanoma is suspected, the patient may undergo additional tests to determine the extent of the cancer, such as imaging tests like CT scans, MRI scans, or PET scans. These tests can help identify any tumors that have spread beyond the skin.

In some cases, patients may also undergo genetic testing to look for mutations that are associated with an increased risk of melanoma, such as mutations in the BRAF gene.

Types of biopsy

Skin biopsy

One of the most reliable ways to diagnose melanoma is through a skin biopsy, a procedure that involves removing a small sample of skin tissue for analysis.

There are different types of skin biopsies, and the type used for melanoma will depend on the size, location, and suspected depth of the tumor. The most common types of skin biopsies are punch biopsy, incisional biopsy, and excisional biopsy.

  • Punch biopsy is typically used for small, superficial lesions, and involves using a special tool to remove a cylindrical sample of skin tissue.
  • Incisional biopsy involves cutting out a small portion of the tumor.
  • Excisional biopsy involves removing the entire tumor.

Once the biopsy sample is taken, it is sent to a pathology lab for analysis by a specialist known as a pathologist. The pathologist will examine the sample under a microscope and look for signs of cancerous cells.

At the Hadassah Clinic, the pathology lab uses state-of-the-art technology and techniques to analyze biopsy samples and provide accurate diagnoses. If melanoma is detected, the patient will be referred to an oncologist for further treatment.

Sentinel lymph node biopsy (SLNB) also is a commonly used diagnostic procedure for melanoma. It involves the removal of the first lymph node(s) that cancer cells are likely to spread to from the primary tumor, known as the sentinel lymph node(s), and analyzing them for the presence of cancer cells.

In melanoma, SLNB is particularly useful in determining the extent of the disease and guiding treatment decisions. A positive SLNB result indicates that cancer cells have spread beyond the primary tumor and may require more aggressive treatment, while a negative result suggests that the cancer is still confined to the primary site.

Tumor thickness

The next stage of diagnosis when the diagnosis is confirmed is the evaluation of tumor thickness using precise microscopic methods. The prognosis is the more favorable the smaller the thickness of the tumor, i.e. the degree of penetration of malignant cells into the patient’s skin. The prognosis is most favorable in non-invasive melanoma, that is, when the disease has affected only the cells of the upper skin layer.

Melanoma treatment at an early stage: surgery

Melanoma surgery

It is necessary not only to remove the entire tumor, but also its “edges”. – i.e. adjacent areas where single malignant cells can be found, which will later serve as a source of metastasis spreading. This stage is critical: on the one hand, trying to minimize the area of skin damage, especially when it comes to areas of the face, lips, etc., on the other hand – remove the puffiness completely, without a trace, to reduce the risk of recurrence. To do this, the most advanced surgical techniques available today are used.

Melanoma surgery is a complex and delicate procedure that requires experienced surgeons and state-of-the-art facilities. The Hadassah Clinic is one of the leading medical institutions in the world for the treatment of skin cancer, including melanoma.

Following surgery, patients receive personalized care from a team of nurses, oncologists, and rehabilitation specialists, who provide comprehensive support to aid in the recovery process.

Removing a prominent area of skin sometimes requires plastic surgery, and that is why melanoma treatment in particular, even at the first stage, is a complex process carried out by a multidisciplinary team of specialists.

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Melanoma recurrence prevention

In a number of cases, melanoma returns even when it is diagnosed at an early stage and the correct and optimal treatment is carried out. Recurrence is prevented by a special vaccination method developed in the laboratory of Professor Michal Lotem.

This is a so-called adjuvant – that is, complementary – therapy intended for patients who have already undergone surgical removal of the tumor. The vaccine is made from a culture of melanoma cells, which are well preserved under laboratory conditions. Usually the patient’s own cells are used for this purpose – from the tumor removed from the patient. This is how an autologous vaccine against melanoma is made. However, in a number of cases where this material is not available (for example, the patient has undergone surgical treatment outside of Israel and has no access to his biological material), a donor bank comes to the rescue. In this case we are talking about an HLA-identical allogeneic vaccine, genetically modified as a strong immune stimulant, made from tumor cells isolated and stored in the laboratories of the Hadassah Clinic’s Melanoma and Cancer Immunotherapy Center.

The melanoma cells are carefully washed and irradiated – during this special treatment, they lose their malignant features and are no longer a danger to the body, but retain their individual characteristics, by which they can be recognized by the lymphocytes that provide immunity to the patient. Conjugation is then performed with 2,4 -dinitrophenyl (DNP), a substance that enhances the T-lymphocyte response: it forms a compound that serves as an antigen, which improves the ability of T-lymphocytes to recognize tumor cells of a given species. From years of research, it follows that vaccination as an adjuvant therapy enhances the immune response against untreated melanoma cells in patients. Thus, this exclusive treatment has proven success in preventing or delaying metastatic recurrence and in prolonging patients’ lives.

Treatment of melanoma in advanced stages

The Hadassah Clinic offers a comprehensive range of treatment options for patients with advanced melanoma, including chemotherapy, immunotherapy, targeted therapy, and cutting-edge clinical trials. With a multidisciplinary team of specialists and a commitment to providing the best possible care, the Hadassah Clinic is at the forefront of cancer treatment and research.

TIL therapy

TIL therapy, also known as Tumor-Infiltrating Lymphocyte therapy, is a type of immunotherapy used to treat advanced melanoma. This therapy involves removing immune cells, called lymphocytes, from a patient’s tumor and multiplying them in a lab. The lymphocytes are then infused back into the patient, where they can target and attack cancer cells. TIL therapy has shown promising results in clinical trials, with some patients experiencing complete remission of their melanoma.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to kill rapidly dividing cancer cells. While chemotherapy is effective at killing cancer cells, it can also damage healthy cells in the body, leading to a range of side effects such as hair loss, nausea, and fatigue. At the Hadassah Clinic, patients with advanced melanoma may receive chemotherapy as a first-line treatment or as part of a combination therapy approach.

Immunotherapy

Immunotherapy drugs work by blocking certain proteins that cancer cells use to evade detection by the immune system, allowing the immune system to recognize and attack cancer cells. At the Hadassah Clinic, patients with advanced melanoma may receive immunotherapy as a first-line treatment, particularly if their cancer has a high level of a protein called PD-L1. Some patients may also receive combination therapy with both immunotherapy and chemotherapy.

Targeted therapy

This treatment uses drugs to target specific molecules or pathways that are involved in the growth and spread of cancer cells. Targeted therapy drugs are designed to be more precise than chemotherapy, meaning they can often spare healthy cells and lead to fewer side effects. At the Hadassah Clinic, patients with advanced melanoma may receive targeted therapy if their cancer has a specific genetic mutation, such as a mutation in the BRAF gene. Targeted therapy may be given alone or in combination with other treatments, such as immunotherapy.

Clinical trials

In addition to these traditional treatment options, the Hadassah Clinic is also involved in cutting-edge research into new therapies for advanced melanoma. This includes clinical trials of new drugs and treatments, such as combination therapies that use multiple approaches to attack cancer cells.

How to come to the Hadassah Clinic for medical treatment?

Coming to Israel for medical treatment is a straightforward process. You will need to contact Hadassah to schedule an appointment and obtain information about the required documentation, including medical reports and passports. You may also need to get a medical visa, which can be done through the Israeli embassy in your home country.

Get a consultation with the Israeli leading melanoma specialists.

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Hadassah University Hospital, Israel

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