Treatment of melanoma depends on the disease stage, the individual's age, overall health, and other factors. Doctors usually develop an individualized treatment plan for each patient.
Melanoma treatment often requires a team of specialists. The team may include:
A dermatologis/dermatologic surgeon (skin specialist)
A plastic and reconstructive surgeon
A medical oncologist (cancer specialist)
Generally one doctor takes responsibility for coordinating care.
Some people with melanoma decide to get a second opinion. They want another doctor to review the diagnosis and treatment plan and make suggestions. A second opinion can be especially important for individuals with melanoma that has spread and is in an advanced stage.
Surgery to remove the tumor is the first treatment used in about 95 percent of melanoma cases. Surgery may be all the treatment needed for small, thin melanomas.
When melanoma is more advanced, other treatments such as chemotherapy (treatment with anticancer drugs) or immunotherapy may be used after surgery to kill cancer cells remaining in the body. This extra treatment is called adjuvant therapy.
In very advanced cases, surgery may not be helpful. The doctor may use only chemotherapy or other treatment methods.
Four kinds of treatment are used for most skin cancers:
Surgery involves removing the tumor and a wide margin of surrounding healthy tissue to reduce the risk that cancer cells are left behind in the area. The amount of surrounding tissue removed depends on the thickness and size of the melanoma. In some cases, the excisional biopsy removes all the cancer and no further treatment is needed.
However, many people need surgery after the biopsy to remove tissue from the edges, or margin, of the tumor. If a wide margin of tissue must be removed, surgical treatment may also include a skin graft. A skin graft involves removing skin from elsewhere on the body and placing it over the incision to replace tissue that was removed.
Surgical treatment of larger, more advanced melanoma may include therapeutic lymph node dissection. This is surgical removal of lymph nodes near the melanoma. This is only done if the doctor found during diagnosis that the melanoma had spread to the lymph nodes.
Chemotherapy involves the use of specialized drugs to kill the cancer cells. For treating melanoma, chemotherapy is given in a pill, injected into the body or given intravenously.
If the melanoma is more advanced, chemotherapy may be administered intravenously through a needle in a vein. This is called "systemic chemotherapy" and can kill cancer cells outside the skin. It may cause nausea and other side effects in some people. Side effects often are mild and usually can be controlled.
Biological therapy, or immunotherapy, uses the body's own natural defenses to help attack and destroy melanoma cells. One form of biological therapy uses cancer-fighting substances that the body makes in small amounts. Larger amounts of the materials are produced in a laboratory and given to the patient. These substances are called biological response modifiers (BRMs).
BRMs include colony-stimulating factors, tumor vaccines, interleukin-2, or interferon-alfa. Biological therapy is used mainly for advanced forms of cancer that cannot be treated with other methods. In some cases, biological therapy is used after surgery to help prevent melanoma from recurring.
This form of treatment uses energy from x-rays or other sources to destroy cancer cells. For melanoma, it usually helps to relieve symptoms that occur when cancer has spread elsewhere in the body.
Radiation therapy is painless and does not make the body radioactive. Several treatments may be needed to kill all of the cancer cells. Radiation therapy may cause a rash, redness, or dryness in the area. Those changes are temporary and disappear in time. Other changes in skin texture or color may develop after radiation therapy. They may become more noticeable years later.
People with melanoma can choose between standard therapy and experimental therapy. Standard therapy is the traditional treatment used by most doctors. Most standard treatments have been in use for years. Standard therapy, however, may not work for all people because it may not cure the disease or it may cause too many side effects.
In such cases, people with melanoma may benefit from experimental therapy. These are newer treatments that scientists are studying in clinical trials. In clinical trials, new treatments are tested on people to see if they are safe and effective.
Clinical trials can give cancer patients access to the newest and most hopeful scientific discoveries. The drawbacks of clinical trials are:
Experimental therapy may prove less effective than more proven therapies.
Experimental therapies may have side effects that have not been discovered yet.
Discussions with the doctor are important in deciding if a clinical trial makes sense for a specific patient.
Need to Know:
A thorough investigation is necessary to decide whether a clinical trial is an appropriate treatment option. For a list of clinical trials, with locations and contact information, visit the clinical trials Web site. http://clinicaltrials.gov
What Kind Of Follow-Up Care Is Needed After Treatment?
People treated for melanoma should see the doctor for regular checkups because they have a high risk of getting melanoma again. They may develop new melanomas or the old melanoma might recur in the original site or in new places in the body. The risk of recurrence is higher for people with thick melanomas or melanomas that spread to other areas of the body.
Regular follow-up care increases the chances that new melanomas will be found in an early and potentially more curable stage. Follow-up visits include:
Thorough review of systems and general examination
Thorough examination of the skin
Possible blood tests and x-rays
Possible scans of the bones, liver, lungs, and brain
Nice To Know:
Q. How often should I return to the doctor for follow-up care after treatment for melanoma?
A. That depends on the stage of your melanoma and a lot of other individual factors. Doctors usually ask patients to return for a complete checkup every three months for the first two years after treatment. Each visit will probably include a complete skin examination, and a check for enlarged lymph nodes. Doctors may order a chest x-ray and scans of the lungs, brain, and other organs depending on symptoms.
Q. My wife was treated for melanoma. Thedermatologist said it was so small and thin that the entire tumor was removed with the excisional biopsy. He thinks that no other tests or treatment are needed. Yet I've heard that melanoma is very dangerous because it spreads. Should my wife have more tests?
A. Melanoma detected in an early stage often can be cured with the excisional biopsy-assuming a margin of normal surrounding tissue was removed (e.g. 5 mm of an in-situ melanoma) consonant with national guidelines. The excisional biopsy removes all the cancer cells before the melanoma has had a chance to spread to other organs. If your wife had Stage I melanoma, the doctor seems to be following national guidelines on melanoma care. These guidelines state that extra tests or treatment are not needed for very early melanoma.