Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

 

Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

 

The four types of standard treatment are:

 

Surgery

Chemotherapy

Radiation therapy

Biologic therapy

 

New types of treatment are being tested in clinical trials. These chemoimmunotherapy.

 

Surgery

Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:

 

Local excision: Taking out the melanoma and some of the normal tissue around it. Wide local excision with or without removal of lymph nodes.

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.

Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.

Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

 

Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to increase the chances of a cure, is called adjuvant therapy.

 

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

 

In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion. This technique sends anticancer drugs directly to the arm or leg in which the cancer is located. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred.

 

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

 

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

 

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

 

Chemoimmunotherapy

Chemoimmunotherapy is the use of anticancer drugs combined with biologic therapy to boost the immune system to kill cancer cells.

 

Treatment options by stage

The four stages are identified in the article on melanoma. Various treatment strategies are available for each stage.

 

stage 0 melanoma

Treatment of stage 0 melanoma is usually surgery to remove the tumor and a small amount of normal tissue around it.

 

Stage I melanoma

Treatment of stage I melanoma may include the following:

 

Surgery to remove the tumor and some of the normal tissue around it.

A clinical trial of surgery to remove the tumor and some of the normal tissue around it, with or without lymph node mapping and selective lymphadenectomy.

A clinical trial of new techniques to detect cancer cells in the lymph nodes.

A clinical trial of lymphadenectomy with or without adjuvant therapy.

 

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

 

Stage II melanoma

Treatment of stage II melanoma may include the following:

 

Surgery to remove the tumor and some of the normal tissue around it, followed by removal of nearby lymph nodes.

Lymph node mapping and sentinel lymph node biopsy, followed by surgery to remove the tumor and some of the normal tissue around it. If cancer is found in the sentinel lymph node, a second surgical procedure can be performed to remove additional nearby lymph nodes.

Surgery followed by high-dose biologic therapy.

A clinical trial of adjuvant chemotherapy and/or biologic therapy, or immunotherapy.

A clinical trial of new techniques to detect cancer cells in the lymph nodes.

 

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

 

Stage III melanoma

Treatment of stage III melanoma may include the following:

 

Surgery to remove the tumor and some of the normal tissue around it.

Surgery to remove the tumor with skin grafting to cover the wound caused by surgery.

Surgery followed by biologic therapy.

A clinical trial of surgery followed by chemotherapy and/or biologic therapy.

A clinical trial of biologic therapy.

A clinical trial comparing surgery alone to surgery with biologic therapy.

A clinical trial of chemoimmunotherapy or biologic therapy.

A clinical trial of hyperthermic isolated limb perfusion using chemotherapy and biologic therapy.

A clinical trial of biologic therapy and radiation therapy.

 

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

 

Stage IV melanoma

Treatment of stage IV melanoma may include the following:

 

Surgery or radiation therapy as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy and/or biologic therapy.

A clinical trial of new chemotherapy and/or biologic therapy, or vaccine therapy.

A clinical trial of radiation therapy as palliative therapy to relieve symptoms and improve quality of life.

A clinical trial of surgery to remove all known cancer.

 

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.