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Treatments of Melanoma
Patients should carefully consider the possible benefits and side effects of any recommended treatment before starting. Surgical removal of the affected skin is the first step in treatment for melanoma. Wide excision is the standard treatment for Stages 0, I and II melanoma. Further treatment will depend on the stage of the melanoma.
Further treatment options include surgery, radiation therapy, chemotherapy, immunotherapy and clinical trials. Surgery, when possible, remains the most effective treatment for metastatic melanoma No new first-line medicines have been approved in over 10 years.
Lymph Node Dissection. The surgical treatment for Stage III melanoma usually recommends a lymph node dissection. If the sentinel node contains cancer (determined on the sentinel lymph node biopsy) then a lymph node dissection (where all the lymph nodes in that area are surgically removed) will usually be the treatment recommended.
Surgery. Metastases to internal organs are sometimes able to be surgically removed, depending on how many are present, their location, and how likely they are to cause symptoms.
Adjuvant (Additional) Treatment. Surgery may be followed with adjuvant therapy for patients with Stages III and IV disease. Adjuvant therapy is additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, immunotherapy or a clinical trial.
Chemotherapy. Chemotherapy is a cancer treatment that uses drugs to slow the growth of cancer cells, either by killing the cells or by stopping them from dividing. Currently, Dacarbazine (DTIC), given by intravenous is the only chemotherapy approved by the FDA for melanoma. Another drug, temozolomide (Temodar), can be given by mouth. The chemotherapy drugs in use at this time are of limited value in most people with Stage IV melanoma. Dacarbazine (DTIC) and temozolomide (Temodar) are the ones most often used, either by themselves or combined with other drugs.
Radiation therapy (Radiotherapy). Radiation therapy uses high-energy X-rays to destroy tissue. It targets the tumor site as well as a surrounding margin of skin. Melanoma is not very sensitive to radiation, meaning radiation does not usually work very well against melanoma cells. In some cases, radiation therapy may be given as an adjuvant to surgery in the area where lymph nodes were removed, especially if many of the nodes were found to contain melanoma. Radiotherapy can provide pain control for melanoma that has spread to the bone. Radiation might also be used in other areas of the body where melanoma has spread. Stereotactic radiosurgery (SRS) treats brain metastasis with a precise delivery of a single, high dose of radiation. Whole brain radiation consists of small daily doses of radiation delivered to the entire brain.
Immunotherapy (also known as biologic therapy). Immunotherapy is a treatment that uses the patient's immune system to fight cancer. One is most likely to hear about interferon-alpha and Interleukin-2 (IL-2). These two drugs are FDA approved for treatment of melanoma. Interferon is used for late Stage II and Stage III disease usually as an adjuvant to surgery. The use of Interferon has been controversial among doctors. Be sure to do your own research and discuss your concerns with your doctor. Interleukin-2 was approved in 1998 for Stage IV disease. Approximately 6% of patients with metastatic melanoma have a complete response to high-dose IL-2 and approximately 10% have a partial response. A complete response is defined as a long-lasting (10+ years) elimination of the disease, although it is not technically a "cure." Responses are seen in patients with a variety of metastases, including in the lung, liver, lymph nodes, soft tissue, adrenal glands and subcutaneous (deep) layers of the skin. IL-2, however, is not recommended for patients with existing brain metastases. To be eligible for IL-2 treatment, you must be in relatively good physical condition, with good heart, lung, liver and kidney function.
Biochemotherapy. Some doctors recommend biochemotherapy. Biochemotherapy is a combination of chemotherapy and biologic therapy. Biochemotherapy is an intensive drug treatment regime that combines three chemotherapy drugs (these drugs can vary) with two active biological agents which are interleukin 2 (IL-2) and Interferon. One is hospitalized for this treatment. The length of the treatment varies according to physician recommendations, patient status and patient response. Do your own research on this treatment choice, discuss your concerns with your oncologist and seek additional opinions if needed.
Hyperthermic isolated limb perfusion. Hyperthermic isolated limb perfusion is another treatment that might be recommeneded if you are experiencing in transit melanoma on your arm or leg. Isolated limb perfusion treats only the affected arm or leg with chemotherapy - not the entire body. Tumors are exposed to a lethal dose of a cancer-killing drug. The procedure does have some risks and varying response rates. It is not indicated in some patients, including those that have significant tumors in areas other than the affected extremity.
Clinical trials. A clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with a disease. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Because Stage IV melanoma is very hard to treat with current therapies, patients may want to think about taking part in a clinical trial. Do research to find the latest available therapies and trials. ClinicalTrials.gov is a registry of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about the purpose of a clinical trial, who may participate, locations, and phone numbers for more details. There are different phase of clinical trials.
Regular follow-up appointments are important once you have been diagnosed with melanoma. Melanoma can come back after any treatment.
Even though the outlook for patients with Stage IV melanoma tends to be poor overall, a small number of patients have responded extraordinarily well to treatment and have survived for many years after diagnosis.
Information on this page has been cited from the Melanoma Research Foundation (www.melanoma.org) - 2011
