Melanoma Resources
This information is explained in much more detail on our sister
website: AboutMelanoma.com.
Melanoma Treatment Options
Surgery
Surgery remains the most effective treatment for most melanomas.
There are two main objectives for surgery. The first is to remove
the tumor and the second is to evaluate the lymph nodes to determine
if the cancer has spread.
Removing the Tumor
Your surgeon removes the tumor and a margin of normal tissue around
it. This procedure, called Wide Local Excision, reduces the chance
that cancer cells will be left in the area. The width of surrounding
skin that needs to be removed depends on the thickness of the melanoma,
but typically a 1 to 2 cm margin of normal skin around the melanoma,
or melanoma biopsy site, is removed.
Evaluating the Nodes
The second main objective of surgery is to evaluate the lymph nodes.
The surgeon does this for two reasons. The first is that knowing
whether the cancer has spread to the lymph nodes tells us about
how aggressive the cancer is and will affect the treatment you receive.
This is called staging. The other reason is that if there is cancer
in the lymph nodes, removal of those lymph nodes is an important
component of the treatment. The lymph nodes are evaluated by a procedure
called Sentinel Lymph Node Biopsy. This procedure concentrates
on locating the sentinel nodes — the first nodes to receive
the drainage from the tumor. The sentinel node, therefore, is the
first lymph node to which the cancer would spread. This procedure
is done after the biopsy of the melanoma and at the same time as
the wide local excision. If a sentinel node contains cancer cells,
your surgeon will recommend removal of the rest of the lymph nodes
in that area. Lymph nodes typically are found in the neck, under
the arms and in the groin area. If a sentinel node is removed, examined
and found to be normal (which happens most of the time), the chance
of finding cancer in any of the remaining nodes is unlikely and
no other nodes need to be removed. Sentinel lymph node biopsy is
a minor outpatient procedure.
Therapy may be given after surgery to kill cancer cells that could
potentially remain in the body for patients with high-risk
melanoma. This treatment is called adjuvant therapy. In addition,
surgery alone is not always effective in controlling melanoma that
has spread to other parts of the body. In such cases, physicians
may use other methods of treatment, such as chemotherapy, biological
therapy, radiation therapy or a combination of these methods. At
any stage of disease, people with melanoma may have treatment to
control pain and other symptoms of the cancer, to relieve the side
effects of therapy, and to ease emotional and practical problems.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may
be recommended following surgery to kill any cancer cells that may
have spread outside the area of your melanoma. Chemotherapy for
melanoma is usually a combination of two or more drugs. The drugs
enter the bloodstream and travel throughout the body.
Chemotherapy side effects may include hair loss, nausea, vomiting
and fatigue. These occur because in addition to attacking cancerous
cells, chemotherapy affects healthy cells — especially fast-growing
cells in your digestive tract, hair and bone marrow. Not everyone
has side effects; today there are better ways to control them if
you do.
Biological therapy
This includes naturally occurring substances found in the body that
stimulate the immune system, such as interferon and interleukin
2. These types of immunotherapy may be beneficial for patients with
high-risk or advanced melanoma.
Biochemotherapy
This is a combination of chemotherapy and biological therapy that
may be beneficial for some patients with advanced melanoma.
Radiation Therapy
Radiation therapy is not needed for the vast majority of patients
with melanoma, but can be helpful in some special circumstances.
Radiation therapy uses high-energy rays to kill any cancer cells
that may remain in the area following surgery. Usually, radiation
is delivered by a technique called external beam, where the affected
area is treated with x-rays. Before you undergo radiation, a radiation
oncologist and physicist plan the precise delivery of the radiation
to minimize radiation to your vital organs and maximize the radiation
to the affected area.