Melanoma Specialist in Guatemala
Advanced melanoma is treatable. And BRAF determines how.
Depending on the melanoma's characteristics, treatment can be a highly specific targeted therapy, or immunotherapy. Knowing which one applies starts with tumor testing that many patients never receive.
When should you consult Dr. Reynoso?
You were diagnosed with stage III or IV melanoma and need an oncologic evaluation
Your melanoma diagnosis doesn't include BRAF mutation testing
You have a skin lesion that has changed in size, shape, or color
The melanoma relapsed after surgery and you're looking for systemic treatment options
You were diagnosed with Merkel cell carcinoma or another advanced skin tumor
You want a second opinion before starting immunotherapy or targeted therapy
⚡ Consultations Monday, Tuesday, and Thursday | By appointment only
50%
of melanomas have a BRAF V600E mutation — eligible for targeted therapy with dabrafenib and trametinib
40-50%
response rate to anti-PD1 immunotherapy in metastatic melanoma
8+
years treating advanced melanoma and skin tumors in Guatemala
Q600
initial consultation with molecular review and treatment plan
BRAF-mutated or not. Two completely different strategies.
Melanoma is the most aggressive malignant skin tumor. In the metastatic stage, treatment fundamentally depends on the presence or absence of a BRAF V600E mutation — identified through molecular testing on tumor tissue.
With a BRAF mutation, the combination of dabrafenib and trametinib produces rapid responses in most patients — with response rates above 60% and immediate clinical benefit. Without a BRAF mutation, or after progression on targeted therapy, immunotherapy with pembrolizumab or nivolumab — with or without ipilimumab — is the treatment of choice. These two strategies aren't interchangeable — and the right decision starts with molecular testing.
“In advanced melanoma, BRAF testing isn't optional. It's the first thing I request before any treatment decision — because it completely changes the strategy.”—Dr. Giovanni Reynoso
Skin lesions that require evaluation.
Melanoma often originates in existing pigmented lesions or as a new lesion. The ABCDE rule helps identify lesions that should be evaluated.
Asymmetry (A)
An asymmetric pigmented lesion — one half doesn't match the other. Melanoma is rarely symmetric.
Irregular border (B)
Poorly defined, irregular, or notched borders. Different from benign moles with well-defined borders.
Uneven color (C)
Color variation within the same lesion — a mix of brown, black, red, white, or blue. Melanoma often has multiple shades.
Diameter larger than 6 mm (D)
A lesion larger than 6 mm — although small melanomas also exist. Progressive growth is the most important sign.
Evolving or changing (E)
Any change in size, shape, color, or symptoms — itching, bleeding, crusting — in an existing lesion. It's the most important sign for urgent evaluation.
New lesion in an older adult
A new pigmented lesion in an adult over 40 — especially in areas of chronic sun exposure — should be evaluated by a dermatologist.
Skin nodule without pigmentation
Amelanotic melanoma — without pigment — is less common but can appear as a pink or reddish nodule without the classic features. Merkel cell carcinoma also presents as a dermal nodule.
Lymph node enlargement without a known melanoma
In some cases, melanoma presents as a lymph node metastasis with no evident primary lesion — melanoma of unknown primary. Requires a complete oncologic evaluation.
Do you identify with any of these?
A first one-hour consultation is enough to begin your workup and, if applicable, reach a clear diagnosis
How advanced melanoma is evaluated in consultation
The oncologic evaluation of advanced melanoma requires histological confirmation, BRAF testing, staging, and a functional status evaluation. The first consultation with Dr. Reynoso reviews what's already complete and which decisions depend on what's missing.
Complete case review
Medical history, biopsy result with histological subtype — superficial spreading, nodular, acral lentiginous, amelanotic melanoma — imaging studies, and prior treatments.
BRAF mutation testing
BRAF V600E and V600K on tumor tissue — if not performed at initial diagnosis, it's requested on available tissue. Determines whether the patient is a candidate for targeted therapy.
Complete staging
Whole-body PET-CT or contrast-enhanced CT of chest, abdomen, and pelvis. Brain MRI — melanoma has a high frequency of brain metastases. AJCC 8th edition classification.
LDH and tumor burden evaluation
Elevated LDH and high tumor burden are negative prognostic factors. In BRAF-mutated cases with high tumor burden and rapid progression, targeted therapy may be the first choice due to how quickly it responds.
Selecting the treatment strategy
BRAF-mutated: dabrafenib plus trametinib as a first option, or immunotherapy. BRAF wild-type: pembrolizumab or nivolumab with or without ipilimumab based on prognostic factors. The optimal sequence is discussed with the patient.
Coordination with dermatology and surgery
In resectable stage II and III disease, coordination with oncologic dermatology and surgery is essential. Dr. Reynoso defines the adjuvant treatment — pembrolizumab or dabrafenib plus trametinib — after surgery.
Why consult Dr. Reynoso for melanoma and advanced skin cancer?
BRAF testing from day one
Dr. Reynoso doesn't design a treatment protocol for advanced melanoma without knowing BRAF status. It's the test that determines the strategy — targeted therapy or immunotherapy — and should be done before any treatment decision.
Immunotherapy and targeted therapy available
Pembrolizumab, nivolumab, ipilimumab, dabrafenib, and trametinib — Dr. Reynoso knows the indications, combinations, and selection criteria for each agent based on the tumor's and patient's profile.
Management of immune-related toxicities
Immunotherapy produces autoimmune toxicities that require early recognition and specific management. Dr. Reynoso monitors the patient during treatment and acts on any toxicity before it becomes severe.
Adjuvant treatment after surgery
In resected stage IIB-III melanoma, adjuvant treatment with pembrolizumab or dabrafenib plus trametinib in BRAF-mutated cases significantly reduces the risk of relapse. Dr. Reynoso evaluates the indication and oversees adjuvant treatment.
BRAF testing from day one
Dr. Reynoso doesn't design a treatment protocol for advanced melanoma without knowing BRAF status. It's the test that determines the strategy — targeted therapy or immunotherapy — and should be done before any treatment decision.
Immunotherapy and targeted therapy available
Pembrolizumab, nivolumab, ipilimumab, dabrafenib, and trametinib — Dr. Reynoso knows the indications, combinations, and selection criteria for each agent based on the tumor's and patient's profile.
Management of immune-related toxicities
Immunotherapy produces autoimmune toxicities that require early recognition and specific management. Dr. Reynoso monitors the patient during treatment and acts on any toxicity before it becomes severe.
Adjuvant treatment after surgery
In resected stage IIB-III melanoma, adjuvant treatment with pembrolizumab or dabrafenib plus trametinib in BRAF-mutated cases significantly reduces the risk of relapse. Dr. Reynoso evaluates the indication and oversees adjuvant treatment.
Received a cancer diagnosis? The next step is a consultation.
First visit, second opinion, or oncologic follow-up — you deserve an oncologist who explains everything.
Medical Oncology in Guatemala City
Dr. Giovanni Reynoso - Oncólogo
Edificio Spazio, 15 avenida y 5 calle 5-50, Vista Hermosa III, Zona 15. Nivel 10, Oficina 10-01Bonanova Health, private hospital specializing in cancer in Zona 15
Office Hours
Monday to Tuesday from 4:00 PM to 6:00 PM Thursday from 3:00 PM to 5:00 PM
Emergency Care
Dr. Reynoso does not handle emergencies. For oncologic emergencies, go to the nearest hospital.
Coverage Areas
Guatemala City
- • Zona 15, Vista Hermosa I, II, and III
- • Zona 10, 14, 16
- • Zona 9, 13
- • Carretera a El Salvador
Metropolitan Area
- • Mixco
- • Villa Nueva
- • Santa Catarina Pinula
- • San Cristóbal
Departmental Coverage
- • All departments of Guatemala
- • Patients traveling from other parts of the country
- • Zacapa, Chiquimula, Izabal, San Marcos, Petén
International Coverage
- • El Salvador
- • Belize
- • Honduras
- • Costa Rica
Common questions, clear answers
Still have questions? Let’s talk directly on WhatsApp for personalized answers.