We talked about the liver, the lungs and other organs as well.

So just removing the tumor out of the mouth of the dog is not going to, you know, cure the dogs of these cancer.

Hey, everybody, welcome back to the blog.

This blog is all about oral malignant melanoma.

I just also dropped another video about melanoma.

So if you're watching this one, I would love for you to go back.

There will be a link below about the other video, because there I will talk an overview just about what melanoma is and some of the other locations that we see it.

So I talked about dermal melanoma in that video.

We talked about digit melanoma as well.

But in this video, we're going to focus on oral malignant melanoma, which is the number one location and the most common oral cancer that we see.

So let's dive in.

We're going to be covering surgery, radiation, systemic therapy, such as the immunotherapy vaccine and some of the prognostic factors.

So let's dive in.

Let's break it down.

So here we are at oral malignant melanoma.

So of the oral tumors, malignant melanoma is the most common one, but it is not the only tumor that we see in the mouth of dogs.

We also see things like fibrosarcomas and squamous cell carcinomas.

And a good rule in general for tumors of the mouth in dogs is that they have a better prognosis if it's of the lower jaw, the mandible, and towards the nose of the dog as opposed to further back.

And a lot of it has to do with accessibility for surgery and being more surgically resectable.

So it's easier to remove a tumor that's of the mandible as opposed to the upper jaw and towards the nose of the dog.

The upper jaw is connected to a lot of the nasal bones and can really start to be more complicated to do surgery.

So that is just a good rule for all oral tumors in general.

So lower jaw more towards the nose of the dog, as opposed to towards the back of the mouth of the dog is going to be easier.

And those tend to have a better prognosis.

And a lot of that is they can remove them more likely with surgical margins.

But so which are the dogs that we tend to see oral malignant melanoma?

I told you it tends to be heavily pigmented breeds.

Those are going to be dogs like Scotties.

We do see them in other breeds as well.

Golden Retrievers are over-representative, Chows, Poodles, Dachshunds.

We see them in black Labradors, unfortunately, as well.

I say that because I have black Labradors, if you don't know that.

And we see them in mixed breed dogs as well.

Tends to be a cancer of middle-aged and older dogs.

And these are cancers that, you know, I think about is two battlefronts.

They're highly locally invasive.

They often can be growing into the bone in the mouth, upper and lower bone, depending where they are.

And the second battlefront is they're highly metastatic.

So they can spread to those lymph nodes.

We talked about the liver, the lungs, and other organs as well.

So just removing the tumor out of the mouth of the dog is not going to, you know, prevent the growth of these cancer and they're very, very highly metastatic.

And I will warn you every once in a while, you will get a biopsy and they'll say that this was a benign one of the mouth.

And in general, most dogs that have an oral melanoma, it is malignant until proven otherwise.

And I've seen ones that have had those biopsies that suggest a benign behavior or a benign biopsy, and they just tend to be malignant.

So I would just be warned.

Some of the ones that are more lip can do better and also be easier to do than some of the ones that are more invasive into bone.

But again, they tend to be a pretty aggressive cancer, both in the mouth and with a high metastatic rate.

For things that have been shown to be prognosis, size has definitely been shown to be prognosis.

And when we talk about the staging system for that, size comes into play.

And so it's, it's broken down, but the smaller we can find them, the better that they do and whether or not they've metastasized to the local lymph nodes and whether or not they have spread distantly to the lungs and the different organs that we've talked about have been shown to be prognostic.

Also other things, incomplete margins.

So dogs that have incomplete margins in one study were three and a half more times likely to die of tumor related causes, whether it was regrowth or metastasis.

So just really emphasizing how important it is to try to find these tumors early and deal with them either with surgery or radiation or some of the things that we'll talk about.

So again, just really important.

Also just something else to emphasize with the highly metastatic rate is these lymph nodes.

In dogs that had big lymph nodes in one study, 70% had metastasis, but normal lymph nodes in the study, 40% still had metastasis.

Just going to emphasize that normal lymph nodes should definitely be worked up with lymph node aspirates.

So just really important that you can't always say, Oh, the dog's lymph nodes are normal.

They didn't need to be aspirated.

So again, this is a highly metastatic cancer and it's just something that we want to emphasize.

And also the lymph nodes are positive for metastasis that changes the stage and changes the prognosis for the dog.

So it's why we want to do it.

So for the what test does your dog need?

Lymph node aspirates, chest x-rays, ultrasound are going to be part of the workup.

And I do recommend that before surgery.

So if the mouth melanomas, the oral melanomas are surgical can be removed if they're not too big, you know, lower towards the front of the mouth.

Surgery is going to be our best treatment option for the dermal ones, the digit ones.

You know, surgery is definitely going to be the primary treatment of choice for the local disease.

So where that tumor is growing.

But the problem is a lot of these ones, especially towards the back of the mouth can be very invasive into bone.

And so if there's any concern, we will often do a CT scan.

Another really important thing is to do that CT before surgery and not try to remove it and then have to try to go back and figure out where they didn't get margins and things like that.

So really a CT scan for these complicated ones, these large ones is going to be really helpful.

And these are ones that I often think a good idea to see a board certified surgeon first because these do often require removal of part of the jaw or they're going to tell us that surgery is not an option.

And then we're going to look for a plan B like radiation, which we're going to talk about in the next part.

All right.

So radiation actually plays an important role for these dogs with either incomplete margins or non-resectable non-surgical melanoma of the mouth.

And even though technically melanoma is considered a radiation resistant tumor, that sounds bad, right?

It's not going to respond to radiation, Dr. Sue.

There are ways that the radiation oncologists have figured out protocols.

And what that means for you and your dog is that the protocols, the take home message is they actually give a higher dose per treatment.

Don't worry about that part.

What I want to know is that it usually means they're not getting those daily radiation protocols with a lot of side effects and each radiation treatment in dogs and cats requires anesthesia, but they're usually coming in once or twice a week, usually weekly for four or six treatments.

Talk to your radiation oncologist.

We'll put a link below.

And I usually leave it up to the radiation oncologist because I'm a medical oncologist and not a radiation oncologist.

And sometimes protocols are changing, but the take home message is because of the way that melanoma cells respond to radiation, they usually do a weekly radiation for about four or six treatments.

And that means not a lot of anesthesia and not a lot of skin and mouth side effects.

So not a lot of burning and things like that.

And so it could be a really good alternative option for these non-surgical cases.

It's often referred to a hypo fractionated protocol.

Just that's what they call it with pretty decent response rates.

So I will often use radiation in these non-surgical cases and send them to a radiation oncologist after talking to the surgeon.

So we all have to work together on these cases.

A lot of the times the radiation oncologist will treat the lymph nodes.

If they were confirmed to be positive with lymph node Asperger's or even prophylactically, they will just treat the neck area as well.

If there are any microscopic cells, that is an advantage of radiation as well is that we can treat the lymph nodes and kill any of those cancer cells with radiation.

So now we've treated the local disease with surgery, the mouth maybe with radiation, but now we need to do something with that second battlefront, right?

The systemic disease, preventing the cancer from metastasizing, you know, is our goal and therapy is always better before the cancer is metastasized and the treatment that we're typically going to be talking about immunotherapy is definitely most effective before the cancer is metastasized.

That's why we want to do those chest x-rays and ultrasound and lymph node Asperger's.

Chemo has not been shown to be super effective for this.

People have looked at Carbo, Platinum, a couple of other chemotherapy drugs, but there's been a little bit of efficacy, but just not, you know, not super effective.

So there's been a lot of research back from the days of my residency at the AMC with the canine immunotherapy melanoma vaccine.

And again, I always remind people when we talk about vaccines, because we think about like giving your dog the vaccine for rabies to prevent an infectious disease.

This is a vaccine.

This is an immunotherapy after your pet has been diagnosed with a cancer.

It's an immunotherapy vaccine to use as a treatment after the cancer is metastasized and the cancer has been confirmed and cannot be used to prevent the cancer.

And this is a vaccine that is now available commercially.

It's called the onset vaccine.

It's a DNA plasmid vaccine targets something called the tyrosinase in the melanoma cancer and has been shown.

And there are studies looking at it for both the melanoma oral form and the digit as well.

And for the oral one, if you looked at the dog's disease free interval, so these are dogs that did not have metastasis and then had surgery or radiation, something to control the local disease in the mouth and then have the melanoma vaccine.

Their cancer did not either come back or metastasize for about 16 months, which is great.

Usually with just surgery alone for melanoma, we see our survival times around six to nine months and median survival times of about 22 months or about 680 days.

So definitely an improvement there. 70% of the dogs are alive at one year and about 30% of the dogs are alive at two years.

How the vaccine works.

It's an intramuscular injection.

It's given two weeks apart for four doses.

So it takes two months to do and then the dogs get a vaccine booster every six months for the remainder of their life usually.

And that is something that I've been doing since the vaccine was approved, I want to say in about 2008 and we continue to use.

And I think the vaccine is now available through VI, was originally through Marielle.

So that, you know, something to talk to your cancer specialist and it is only available in general from cancer specialists.

So it's not going to be something that you're going to get from your general practitioner.

So you can talk to them about it or see a cancer specialist, but definitely the systemic therapy that I recommend for my patients with malignant melanoma, both digital and the oral one as well.

And that wraps up our video on oral malignant melanoma.

I hope you found it helpful.

Don't forget there is a part, another part where you can go and get that overview on melanoma.

If you haven't yet watched it, please let me know what other topics you'd like to see.

Don't forget to subscribe and also don't forget how important early detection is when we talked about size being important and how hard it is to do a really good, you know, exam and we need to be careful when we're going in our own pet's mouth and your veterinarian, a great opportunity for them and a veterinary technician to get a great oral exam is when they're going in for their dentals.

And so for most middle-aged and older dogs, we're recommending dentals one to two times a year.

So that's going to be another great way, not only to get their teeth clean, but to evaluate for these oral tumors.

So again, I hope that you found this video helpful.

Thanks so much for watching.

And I look forward to seeing you at the next video.