Melanoma Treatment

If you are diagnosed with melanoma, you should begin treatment soon after diagnosis. This cancer is very curable when caught early and treated. Waiting gives the cancer a chance to grow deep or spread. Treatment then becomes more difficult, and the cure rate drops.

The following describes treatment that may be recommended. Your doctor carefully considers many factors before recommending treatment. Sometimes more than one treatment is recommended.

Be sure to ask your doctor to explain your personal risks and benefits for the treatment that is recommended.

Surgery
Surgical Excision: This is the most common treatment. It is used to treat patients who have early melanoma. It is used to treat patients who have advanced melanoma. Surgical excision is similar to the biopsy. During surgical excision, though, the doctor removes a wider and deeper amount of skin.

When a patient has an early melanoma, the dermatologist can perform surgical excision during an office visit. To perform this surgery, the dermatologist will:

  • Numb the area

  • Cut out any remaining melanoma not removed during the biopsy

  • Remove surrounding normal-looking skin

  • Close the area with stitches

  • Send the removed skin to a lab

At the lab, the skin will be examined under a microscope for cancer cells. Your dermatologist will receive a report from the lab. It will tell your dermatologist whether a portion of the normal-looking skin is free of cancer cells. This is the goal for this type of treatment.

Sentinel Lymph Node Biopsy (SLNB): This is not a treatment. It is a type of surgery used to find out whether the melanoma has spread to a patient’s lymph nodes (what many people call lymph glands).

Here are key facts about a SLNB:

  • Usually recommended when melanoma at least 1 millimeter deep. At this depth, there is a greater risk that the melanoma cells have spread to the lymph nodes closest to the melanoma.

  • When melanoma spreads, it often first travels to the lymph nodes closest to the melanoma. The first node to get melanoma cells is called the “sentinel lymph node.”

  • To find the sentinel lymph node, the surgeon injects a blue dye or radioactive material.

  • About 30 minutes after injecting the dye, or other material, the surgeon sees where the sentinel node lies.

  • The surgeon makes a small incision and removes the sentinel lymph node.

  • Like the original biopsy, the node is sent to a lab.

  • The node will be examined under a microscope for cancer cells.

If the lymph node contains cancer cells, the patient has stage III melanoma. Treatment becomes more complex, but it can sometimes still cure the disease.

Lymph Node Dissection: This surgery is often recommended when:

  • Cancer cells are found during the SLNB

  • Your doctor feels a hard or swollen lymph node during the physical exam

During this surgery, the surgeon removes the lymph nodes that lie closest to the melanoma on the skin.

Adjuvant Therapy
“Adjuvant” means supplemental. When there is a risk that the melanoma has spread, adjuvant therapy is often recommended. It is called adjuvant because it is given after the first treatment. Adjuvant therapy helps kill melanoma cells.

Patients are typically referred to a medical oncologist to discuss adjuvant therapy. An oncologist is a doctor who specializes in cancer. The oncologist may recommend one or more of the following types of adjuvant therapy:

Immunotherapy: This treatment strengthens the patient’s immune system so that the patient’s body can better fight the cancer. Interferon, melanoma vaccines, and biologic medicines are types of immunotherapy given to treat melanoma.

Clinical trial: The purpose of a clinical trial is to evaluate a medicine or other treatment. A doctor may recommend a clinical trial when the medicine or other treatment could help a patient.

Chemotherapy: This treatment works by either killing cells or preventing cells from dividing. When receiving chemotherapy for melanoma, the patient may take an anti-cancer medicine or a combination of medicines. To receive chemotherapy, a patient may take pills or receive infusions. Both methods send the medicine throughout the body. Chemotherapy kills cancer cells. It also kills some healthy cells, which may cause side effects.

Radiation therapy: Radiation therapy uses x-rays to kill cancer cells. It is not as effective for melanoma as it is for some types of cancer. For select patients with melanoma, radiation therapy may be recommended. Radiation kills the cancer cells. It also kills some healthy cells. The goal is to kill as few healthy cells as possible.

Palliative Care
This care can relieve symptoms and improve a patient’s quality of life. It does not cure the cancer. Many patients receive palliative care, not just patients with late-stage cancer.

When melanoma spreads, palliative care can help control the pain and other symptoms. Radiation therapy is a type of palliative care for stage IV (spread beyond the lymph nodes) melanoma. It can ease pain and other symptoms.

Follow-up Essential
Melanoma can return. If you have had melanoma, you have a higher risk for developing another melanoma. This makes follow-up appointments with your dermatologist or oncologist essential. During these appointments, your doctor will look for signs of melanoma. The cure rate for new melanoma is very high. Be sure to keep every appointment.

More Information
Melanoma: How it Returns, Where it Spreads

Reference:
Bichakjian CK, Halpern AC, Johnson TM et al. “Guidelines of Care for the Management of Primary Cutaneous Melanoma,” American Academy of Dermatology, published spring 2011.
 


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Page last updated 7/1/11

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