When most people think of melanoma, they think of skin cancer. If left untreated, melanoma can spread throughout the body. But in rare cases, melanomas start in the esophagus or the stomach or elsewhere in the gastrointestinal tract. Unfortunately, these rare melanomas are diagnosed late, tend to be more aggressive, and are associated with a worse prognosis.
And because these melanomas are so rare, relatively little research has been done on them. Pauline Xu, MD, PhD, a first-year resident in UNMC’s Department of Pathology, Microbiology and Immunology, hopes to change that. She and her mentor, Dinesh Pradhan, MD, an associate professor in the department, are doing a study they hope will start to bridge that knowledge gap.
“One of the things we’re trying to understand is what kind of changes in our DNA can drive that process and find ways to hopefully target that,” Dr. Xu said. Because so far in trials for patients who have this rarer type of melanoma, she said, current immunotherapy options haven’t consistently had the same efficacy for them.
Dr. Xu said they have searched through UNMC’s pathology archives and identified 39 patients over the past 34 years with primary gastrointestinal melanoma.
“We’ve already started looking at what kind of factors might be important in terms of survival, how long have these patients survived, what kinds of therapy they have received, features like that,” she said. “We are working on multiple fronts trying to better understand the nature of the disease.”
That includes identifying molecular changes in tumors from these patients. They will obtain specimens from biopsies or resections and use next-generation sequencing for comprehensive genomic profiling. This is all in an effort to improve detection and treatment.
“Currently, there is no standard staging system and limited consensus on optimal management of these extremely rare melanomas. We are trying to find prognostic and predictive biomarkers which can help us better manage these patients,” Dr. Pradhan said.
Dr. Xu’s study is made possible by the department’s Research Grant Awards, created in 2024. The awards provide up to $10,000 in research funding to residents and fellows. The aim of this program is to advance the experience and mentorship in clinical and translational research.
Dr. Xu, born in Iowa, grew up in Maryland and earned her bachelor’s degree there. She spent a gap year at the National Institutes of Health as a postbaccalaureate fellow before joining UNMC’s MD-PhD Scholars Program in 2016. After two years of medical school, she transitioned to her PhD program in cancer research. After successfully defending her dissertation and receiving her PhD in 2022, she returned to medical school, graduating last May and starting her anatomic and clinical pathology residency here in the summer.
The MD-PhD program gave Dr. Xu a wide-ranging experience that spans scientific research and clinical medicine. “I’d love to be able to still participate in research,” she said, ideally at an academic institution where she could divide her time between research and clinical work.