Treatment Options for Melanoma

HOW IS MELANOMA TREATED?

Below is a description of possible melanoma treatments. It is not meant to be exhaustive, but will give you an idea of some of the treatments available.

Surgery

A standard treatment for melanoma is surgery to remove all or part of the disease. For primary melanomas, the width and depth of the area of skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin.

Sometimes very thin melanomas can be completely removed by a simple excision surgery, which means that the doctor cuts out the tumor, along with a margin of normal-looking skin. The site may need to be excised again (a re-excision) if the skin biopsy confirms the presence of melanoma. This is because the surrounding tissue needs to be examined to ensure that no cancer cells remain in the skin. If a large area of tissue is removed, a skin graft may be performed at the same time, during which skin from another part of the body is used to replace the skin that was removed. The doctor may also remove lymph nodes near the tumor to check for melanoma cells, which would indicate that the cancer may have spread to other parts of the body.

If melanoma is known to have spread to other parts of the body such as the lung, liver or brain, surgery may sometimes still be used, even if it is just to remove a few areas of disease that have spread. Often, other methods of treatment such as chemotherapy, immunotherapy or radiation therapy (see below) are used in addition to or instead of surgery for patients with advanced disease. If an additional treatment is used after surgery, the surgery is called the primary therapy and the additional treatment is called the adjuvant therapy. The goal of adjuvant therapy is to kill any undetected cancer cells that may remain in the body.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Because these drugs are injected into a vein or given by mouth, they enter the bloodstream and reach all areas of the body, making it useful for disease that has spread to distant areas. Chemotherapy drugs used to treat melanoma include DTIC-Dome^® (dacarbazine) and/or Temodar^® (temozolomide), which are sometimes used for some patients with stage IV melanoma, especially to relieve symptoms or shrink tumors. Chemotherapy is usually provided on an outpatient basis, although a short hospital stay may be needed depending on the specific chemotherapies used and the patient’s general health. Because chemotherapy can damage healthy cells in addition to cancerous ones, this type of treatment can be associated with side effects.

Immune therapy

Immune therapy (also called immunotherapy) is a form of treatment that uses the body’s natural ability – the immune system – to fight cancer or to lessen side effects caused by some cancer treatments.

Therapy with cytokines (proteins that stimulate the immune system in a general way) such as interferon alpha and interleukin 2 can help shrink metastatic melanomas in some patients. Cytokine therapy can be associated with side effects such as fever, chills, aches and severe fatigue.

Vaccine therapy includes injecting certain substances or molecules found in melanoma cells to try to stimulate the body’s own immune system to destroy cancer cells. There are several ways of doing this, including using molecules unique to melanoma as well as to an individual patient's cancer. Clinical trials are currently underway to test the value of treating people with advanced melanoma with vaccines.

Radiation therapy

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. In melanoma treatment, radiation therapy is not commonly used to treat the primary tumors of melanoma. Rather, it is most commonly used to help control melanoma that has spread to the brain, bones and other parts of the body, and can also be used to relieve some of the symptoms caused by melanoma.

Clinical trials

Also called medical research or research studies, clinical trials are designed to determine whether new drugs or treatments are both safe and effective. Research studies are only done when there is good reason to believe that the new treatment may be of value to patients. The trials are conducted to answer questions such as if the new treatment is helpful, if it works better than what is currently being used, what side effects the new treatment may have and which patients are likely to benefit the most from it. Click here for more information about clinical trials.

WILL I BE BACK TO NORMAL AFTER MY MELANOMA TREATMENT?

Quality of life after melanoma treatment will vary from patient to patient. For some, life after treatment is very similar to life before treatment. Others may require additional treatments such as chemotherapy or radiation therapy, which can be associated with side effects.

Cancer treatment can make you feel tired so give yourself time to recover. Don’t feel you have to rush back to work or resume all of your normal activities right away.

Once you recover from your treatment, do as much as you can to help yourself stay healthy and active such as quitting smoking, eating healthy foods like fruits, vegetables and whole grains, and exercising, as directed by your doctor.

IS IT NORMAL TO FEEL ANXIOUS AND SCARED?

Dealing with a serious illness is not easy. But doctors, nurses and other members of your health care team can answer many of your questions. Often, a social worker can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation or home care. Meeting with a counselor or spiritual advisor can also be helpful if you want to talk about your feelings or discuss your concerns.

Just as each person is unique, so are each person’s needs and circumstances. Everyone handles challenging situations differently and it is natural to feel anxious and scared when faced with a diagnosis of cancer. Keep in mind that nonmedical factors such as exceptionally supportive family and friends, a positive outlook or a profound spiritual faith may help you better cope with the days ahead.