Melanoma, Sarcomas and Rare Tumors Program


The Melanoma, Sarcoma and Rare Cancer Program has the following divisions:

>> Melanoma and sarcoma Oncology Division
>> Sarcoma and thymoma Oncology Unit
>> Melanoma Oncology Unit
> Melanoma and sarcoma and rare Cancers Surgery Division


Vision and Mission

The Melanoma, Sarcoma and Rare Cancers Programme (MSTR) is a heterogeneous programme which aims to optimise scientific, logistic and care resources in order to treat individually rare tumours which present similarities from an intellectual and therapeutic review, such as to justify their unified treatment.

IEO is able to offer patients with a rare tumour the same competence and quality of care as for patients with more common cancers. The focus of the diagnostic-therapeutic-support pathway is the patient, with the combination of his or her clinical and mental and physical characteristics and the biological characteristics of his or her disease.


The Melanoma, Sarcoma and Rare Cancers programme is based on a multidisciplinary approach aimed at the diagnosis and treatment of low incidence tumours, which involves the contribution of dedicated specialists: oncologists, surgeons, dermatologists, radiotherapists, anatomic apologists, radiologists, psychologists, physiotherapists, research nurses, et cetera.

The Melanoma and skin cancer specialists are dedicated to the prevention, early diagnosis, surgery and medical therapy in all phases of the disease. Via the availability of numerous clinical research programmes, in addition to standard therapies patients, above all, also have access to more innovative and promising treatments.

The soft tissue sarcoma specialists work in collaboration with other national and international centres of reference. The treatment programmes take the form of a combination of surgery, medical therapy and radiotherapy, as well as reconstructive surgery and rehabilitation. The complexity of the approach to the patient with soft tissue sarcoma is therefore more oriented to customised care. Treatment options are also available for soft tissue sarcomas, whether standard or as part of clinical research studies.

Rare cancer specialists set themselves the objective of creating a point of reference for patients with less widespread tumours, such as Thymomas, Mesotheliomas, Neurofibromatosis, Merkel cell carcinoma, Kaposi sarcoma.

Clinical activities are enriched by the collaboration of IEO researchers who study models of cancer progression, the development of new molecules able to hit precise molecular targets and the mechanisms that are involved in the inflammatory and immune responses in cancers. The activity is recorded and monitored in an institutional database that has been active for years and managed by the Epidemiology and Biostatistics Division of IEO.


    The melanoma activity is divided into various levels:


    - surgery

    - treatment of metastatic disease



    The diagnostic activity takes the form of various stages:

    a)      early diagnosis of skin cancers (melanoma and non-melanoma skin cancer). This activity takes place in dedicated clinics for the first and follow-up visits and makes use of avant-garde technologies such as videodermatoscopy and confocal laser microscopy. The activity is for both healthy subjects (screening) and for patients with melanoma and other skin cancers

    b)      surgical treatment of skin cancers: surgical removals of skin cancer or suspected lesions are performed in day surgery

    c)   post surgical wound medications in dedicated clinic

    d)   clinical follow-up for patients enrolled in research protocols which require periodic dermatology visits

    e)   dedicated clinic for dermatological screening of patients undergoing cancer screening within the hospital area used for oncology check-ups

    f)   consulting activities in the various admission areas of the Institute on request of the hospital doctors for admitted patients who present skin problems

    g)   dedicated clinic for vulvar pathologies, in collaboration with Colleagues of the Preventive Gynaecology Division


    New skin diagnostics clinic: dedicated, recently introduced clinic for prevention and early diagnosis in patients with suspected skin cancers and patients with a high risk of skin cancer (melanoma and non-melanoma skin cancer)

    A customised pathway is developed for the patient which may include dermatology visit + videodermatoscopy (digital mapping) + potential confocal microscopy + any skin biopsy/surgical removal on the same day through the use of two adjacent clinics. This is a unique service in Italy, contracted to the Italian Health Service (SSN).


    The following clinics will be activated in the future:

    - skin onco-toxicity clinic: dedicated to the recognition and management of the cutaneous effects of systemic cancer treatments and radiotherapy: in a Cancer Centre like the IEO, this activity is essential for supporting patients during treatment

    - dedicated clinics for selective photothermolysis, cryotherapy and diathermocoagulation for the treatment of precancerous disorders (actinic keratosis, HPV-related lesions, et cetera)


    The disease diagnosed and its local or loco-regional extension is most often treated with surgery alone.

    -          Surgery of primitive melanoma and non-melanoma skin cancers

    -          Treatment of disease localised in the lymph nodes

    -          Treatment of metastatic, extra lymph nodal disease

     -          Second opinion


    As regards systemic treatment, the programme makes use of a group of oncology specialists dedicated to the pharmacological treatment of the diseases, which involve the use of immunotherapy, target therapy, chemotherapy and logo-regional therapies. Thanks to the active role played in more recent clinical research, our Oncology is considered a national and international centre of reference for the diagnosis and treatment of these diseases by the most modern strategies. Close collaboration with other specialists, such as surgeons, radiologists, interventional radiologists, radiotherapists and anatomical biologists and psychologists, facilitating the interaction between the various disciplines, enables combining the various options and proposing innovative therapeutic programmes.  In addition, active participation in the last 10 years in the most important clinical studies on investigational treatments, has enabled access to new effective therapies for hundreds of patients much sooner than they are registered and marketed. Clinical research therefore remains a priority of the Division to continue to offer patients the most modern drugs available. Oncology is today managing around 40 research protocols concerning both early and advanced stages of disease. As well as clinical research, the Division is engaged in translational research projects, which involve a close interaction with the raw researchers, to translate the results of lab studies into the clinic. Vaccine therapy programmes, creation of cell lines and identification of prognostic factors are currently under development.


    Soft tissue sarcomas are rare mesenchymal tumours that originate from the connective and muscular structures. The parts of the body most affected are the limbs in 59% of cases, followed by the retroperitoneum in 15%, trunk 10%, head and neck 5%, visceral areas (oesophagus, intestine, stomach, uterus, et cetera) 10%. They form around 1% of adult cancers, with a prevalence in males, the incidence is around 5 cases a year for every 100,000 people.  There are peaks in paediatric age and after six years.

    More than 70 different isotypes of soft tissue sarcoma are known, classified according to morphology.


    A patient treated at our institution may receive a conventional treatment, as part of consolidated guidelines, or a custom treatment, depending on the individuality of each individual case. There is still the possibility of receiving a treatment as part of the clinical study (for example on a new drug or a new innovative therapeutic strategy).


    From a methodological point of view, all clinical decisions are discussed in a multidisciplinary environment, sharing the case between surgeons, oncologists, radiotherapists, thoracic surgeons, plastic reconstructive surgeons, physiotherapists, cancer psychologists, radiologists and pathologists.


    The primary curative treatment of sarcomas today is surgery, preferably carried out in centres of reference, in order to apply the due oncological indications and through the greater experience. Surgery can be integrated with chemotherapy and radiotherapy. In particular, resulting to radiotherapy enables obtaining control of the disease, with good results in 85-90% of cases with good disease stabilisation for years.


    Often the therapy includes multiple treatment methods, sequentially through the treatment programme, and which consist of surgery, radiotherapy and chemotherapy. These can be combined in different modes and therefore the treatment methods vary according to the disease characteristics. It is therefore essential to attend specialist centres for the management of sarcoma. The heterogeneity of the anatomical presentation is one of the greatest difficulties and the fact that it can arise anywhere means that surgical intervention may also involve all anatomical areas and the collaboration of various surgical specialists.


    According to the type of intervention, the site, the isotype, the grading, examination, the surgery will be performed following local radiotherapy. The radiotherapy, i.e. the application of radiation capable of killing cancer cells, is performed on precise sites, with targeted dosage and according to methods which vary by the type of cancer, as not all sarcomas respond in the same way. Lastly, in relation especially to the staging of the disease, chemotherapy is used, which involves intravenous infusion or oral administration of drugs that can select and kill cancer cells. The most active drugs are represented by doxorubicin (or epirubicin), ifosfamide, in soft tissue sarcomas, to which other drugs can be added such as trabectedin, taxanes and more besides.


    -          Diagnostic radiology, for defining the local extension and morphological characteristics

    -          Pathological and molecular diagnosis, for defining the class of risk

    -          Local treatment, neoadjuvant and adjuvant treatment

    -          Treatment of advanced disease

    -          Second opinion



    The Melanoma, Sarcoma and Rare Cancers Programme includes:


    -          training programmes for members of staff, via active participation in training activities nationally and internationally

    -          training programmes for general physicians and specialists

    -          educational programmes for patients and families.



Università degli Studi di Milano Ecancer Medical Science IFOM-IEO Campus


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© 2013 Istituto Europeo di Oncologia - via Ripamonti 435 Milano - P.I. 08691440153


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