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What Is Melanoma? | High Risk Melanoma | Incidence and Risk Factors | Symptoms and Diagnosis | Stages | Treatment
Get answers to your Melanoma questions.
Dr. Hausner’s Bio | Q&A Archive
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The treatment for melanoma may include surgery, radiation, chemotherapy, or immunotherapy. The treatment that is recommended depends on the stage of the melanoma.
Surgery
Surgery is the primary treatment for stage 0-III melanoma. There are several surgical procedures that are used to manage patients with melanoma. The choice of procedures depends on the stage of disease.
Wide local excision: In the majority of patients with melanoma, the primary lesion can be removed by a procedure know as a wide local excision. This procedure removes the abnormal melanoma cells, as well as a margin of normal tissue surrounding the abnormal melanoma cells. The size of the wide local excision varies depending on the thickness of the primary tumor. A wide local excision procedure is performed in the operating room but generally does not require admission to the hospital.
Lymph node evaluation:
Sentinel lymph node biopsy: A sentinel lymph node biopsy is a procedure that allows a surgeon to identify and remove lymph nodes that are most likely to contain abnormal melanoma cells from the primary melanoma lesion. This procedure is performed for all patients with melanomas that are >1.0 mm in thickness and for some patients with high-risk melanomas that are <1.0 mm thick.
Lymph node dissection: A lymph node dissection is a procedure that removes all lymph nodes in a particular area of the body. This procedure is performed if abnormal melanoma cells are identified in the lymph nodes that are near the primary melanoma lesion.
Radiotherapy
Radiation therapy is the use of high-energy x-rays to kill cancer cells. There are several situations in melanoma patients in which radiation may be used. Sometimes radiation is used in addition to lymph node dissection if a significant amount of melanoma cells are identified in the lymph nodes at the time of removal. Radiation to the lymph nodes is also considered in patients who have recurrent disease in the lymph nodes. Finally, radiation may also be used to control disease when cancer cells have spread to the brain.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy can be given by many methods including intravenously (IV), intraarterially (IA), intramuscularly (IM), and orally.
Chemotherapy can be given systemically (to the entire body) to treat patients with melanoma who have metastatic disease. The most commonly used chemotherapy agents for metastatic melanoma are dacarbazine (DTIC) and temozolomide.
Chemotherapy may also be given regionally (into a localized area of the body) in melanoma patients who have disease which is confined to a limb. This is done by isolating the blood vessels in the limb and delivering the chemotherapy through a circuit between the two vessels. This technique is known as isolated limb perfusion.
Immunotherapy
Immunotherapy is the delivery of agents into the body in an attempt to stimulate the body's own immune system to fight cancer cells. Multiple immunotherapy regimens have been evaluated in patients with melanoma including interkeulin-2 (IL-2), interferon-alpha-2B (IFN- α), and vaccines. The success of these different therapies has been variable and is very dependent on patient selection. Immunotherapy has been used as additional therapy for patients with stage III disease following surgery or for patients with metastatic disease.
Biochemotherapy
More recently combination chemotherapy and immunotherapy, known as biochemotherapy, has been evaluated for patients with metastatic melanoma in an attempt to improve response rates and outcome.
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