Advanced melanoma care: Multidisciplinary melanoma clinic and total body photography

The Nebraska Medicine multidisciplinary melanoma clinic brings together specialists in medical oncology, dermatology, surgical oncology, and other specialties. 

"Melanoma care requires a multidisciplinary approach," says dermatologist Jesse Hirner, MD. "Having everybody there in clinic together allows for real-time communication as opposed to sending Epic messages, emails or texts back and forth."

The advantages of this model include:

• Coordinated treatment planning: Many melanoma patients require synchronized surgery and immunotherapy.
• Evidence-based care: Research shows improved patient outcomes with this model of care.
• Rapid side effect management: More efficient addressing of immunotherapy side effects, which are common in advanced melanoma care.

The team also holds a weekly melanoma tumor board where complex cases are reviewed by additional specialists from head and neck surgery, radiation oncology, pathology and surgical and medical oncology.

"We're able to leverage a lot of expertise and experience,” Dr. Hirner says. “All our complex melanomas are brought in and discussed there, so you get customized care for that individual patient.”

Integrated specialties for enhanced care

The multidisciplinary melanoma clinic was created by complex general surgical oncologist Joshua Mammen, MD, and medical oncologist and hematologist Alissa Marr, MD. 

Dr. Hirner joined Drs. Mammen and Marr in the clinic in July 2025. He focuses on the early detection of local recurrences and second primary melanomas, which he says are more common than recurrence.

"We know our melanoma patients are at relatively high risk of having a subsequent melanoma,” he says. “Close surveillance is really important because, when detected early, melanoma required only a minor skin procedure, and we're able to cure that the vast majority of the time. But when detected late, it's more difficult to deal with."

Patient referral criteria

Patients who should be referred to the multidisciplinary melanoma clinic include:

• Those with advanced-stage melanoma.
• Patients with complex treatment needs requiring coordination between multiple specialists.

Total body photography for early detection

Total body photography is a new approach to skin cancer monitoring that enhances detection capabilities.

"Total body photography is full head-to-toe photography usually done once a year," Dr. Hirner says. "The patient will leave their undergarments on, so they're not completely nude. Our platform, called FotoFinder, involves 100x magnified dermoscopy – really magnified, high-resolution imaging underneath the surface of the skin to allow us to better diagnose early skin cancer."

Advantages of this technology include:

• Enhanced detection: Ability to track changes in granular detail.
• Documentation of baseline appearance: Allows comparison to detect new spots or changes in existing lesions.
• Reduced unnecessary biopsies: Better visual data helps avoid unnecessary procedures.
• Integration with Epic: Images will sync to Epic, making them available to all providers on the care team.

The FotoFinder system incorporates artificial intelligence to help identify suspicious lesions.

"AI has a lot of promise in early detection of melanoma as well as other types of skin cancer,” Dr. Hirner says. “Certain AI models actually perform better than a dermatologist."

Patient selection criteria

Total body photography is targeted at high-risk individuals, including:

• Patients with previous melanoma diagnosis.
• Those with a strong family history of melanoma.
• Individuals with known genetic syndromes that increase melanoma risk.

"We're focused on patients who are at high risk of developing melanoma," Dr. Hirner says. "Screening low-risk patients would be an unnecessary cost to them.”

Insurance coverage

Insurance coverage for total body photography has been increasing in recent years as evidence for its clinical utility grows.

"In our market analysis of Nebraska, we anticipate about half of patients will get insurance coverage for it," Dr. Hirner says. "Just five years ago, it was never covered by insurance. We're seeing increases in coverage as data demonstrates more usefulness."

Collaborative care model

Total body photography enhances collaboration between primary care physicians and dermatologists. 

"Primary care doctors and oncologists caring for these patients will have access to their images," Dr. Hirner says. "If a patient asks, 'Hey, Doc, what about this mole?' they'll be able to look at that and say, 'This is what this looked like previously. Has it changed?'"