Treatment

Treatment for melanoma is based on the stage.  Generally, it consists of first surgically removing the tumor and then staging the disease’s progress through pathology reports. 

Insitu melanomas (Stage 0) are generally cured by removing a small amount of surrounding skin and the lesion itself.

Stage I and Stage II melanomas are surgically cut out with a larger amount of adjacent tissue removed.  Tumors of less than or equal to 1 mm thickness are excised along with 1 cm of surrounding tissue.  Tumors of 2-4 mm thickness are excised along with 2-3 cm of surrounding tissue.  Current recommendations are for these stages to have a sentinel lymph node biopsy.  If the node(s) is positive for melanoma, then more lymph nodes are removed (lymphadenectomy).  After surgery and SLNB, adjuvant therapy may be started.  Adjuvant therapy is simply any additional treatment beyond the primary treatment (surgery). This may include chemotherapy and/or biological therapy.  Chemotherapy is generally given as an intravenous injection of chemicals into the body’s system.  This kills the cancer cells in different ways like not allowing them to reproduce.  Biological therapy (also called immunotherapy) is a treatment that works inside of your body’s defense system to either fight the cancer by strengthening your immune system or by decreasing reactions from the chemotherapy.  Interferon, BCG and interleukin-2 are examples of biological therapy.  Clinical trials are sometimes used in Stage II melanomas.

Stage III melanomas are excised with yet a greater area of surrounding skin removed.  Often the wound is so larger that it requires skin grafting to close.  Surgery is followed by chemotherapy, biological therapy, radiation therapy and/or a combination of all three. Radiation therapy is the use of radioactive waves to kill the cancer cells.  Radiation can be done externally by a machine shooting focused x-rays at the affected area or performed internally by implanting a radioactive material housed in a small container (seed, wire, catheter). Clinical trials abound for this stage of melanoma.  Since it is more advanced, a newer treatment found only in a clinical trial may be of benefit.

Stage IV melanomas are excised mainly to treat pain and relieve other symptoms since the melanoma has already metastasized to other body parts.  For instance, if the melanoma has spread to the intestines and caused a blockage by growing a large tumor, the part of the intestine affected will be debulked  (have the tumor removed) to prevent death from intestinal obstruction.  Some centers remove all the existing tumors.  Chemotherapy, biological therapy and clinical trials are all used in this stage.  Vaccines are in the experimental phase and being used in clinical trials in this stage.

For more information, please visit:

Treatment Options Overview:

http://www.nci.nih.gov/cancertopics/pdq/treatment/melanoma/Patient/page4

Treatment Options by Stage:

http://www.nci.nih.gov/cancertopics/pdq/treatment/melanoma/Patient/page5

For Multidisciplinary Centers that specialize in melanoma treatment:

http://www.skincancer.org/melanoma/treatment-centers.php