Melanoma treatment
The treatment of melanoma depends on the stage the cancer has reached. The main treatments are surgery, chemotherapy, and treatment with biological therapies. Early-stage melanoma is usually treated with surgery only, with an excellent chance of cure. Where there is a higher risk of the melanoma coming back after surgery, doctors may recommend a course of treatment to try and prevent this. This is called adjuvant therapy. Melanoma that has spread to other parts of the body (stage 4) is treated with chemotherapy or biological drugs. Radiotherapy is sometimes used to treat melanoma that has spread to the lymph nodes .
New melanoma treatments are also being developed and may be given as an addition to the standard treatment for some patients as part of a clinical trial.
Surgery
Surgical removal of the tumor is the main treatment for melanoma. This is usually done in an operation called a wide local excision. The surgeon removes the melanoma and a border of healthy tissue around it.
To see whether the cancer has spread to the lymph nodes , the surgeon may do a sentinel lymph node biopsy. This means removing the first lymph node that receives fluid from the affected area. If it contains cancerous cells, the rest of the lymph nodes in the area will have to be removed. If the cancer has obviously spread to nearby lymph nodes – for example, if they are enlarged – the surgeon may remove them without doing a sentinel biopsy first.
Chemotherapy
Chemotherapy can be used to treat melanoma that has spread around the body (metastatic melanoma). However, there is no standard type of chemotherapy for melanoma. This is because doctors have not yet found a combination of chemotherapy drugs that is as effective as they would like.
Chemotherapy may cause side effects because it targets all fast-growing cells, and not just cancer cells. These side effects may include anemia, nausea, vomiting, diarrhea, hair loss and general fatigue. They can be severe, although anti-sickness medicines can help make them easier to deal with.
If melanoma in an arm or a leg comes back after surgery, chemotherapy is sometimes given to the affected limb only. This involves a procedure called isolated limb perfusion.
Biological therapies and immunotherapy
Biological therapies are treatments made from substances that are produced naturally by the body. A biological therapy called interferon alfa can be used in addition to surgery to treat melanoma that has spread. It can be used on its own or in combination with chemotherapy drugs. The main side effects of interferon are severe tiredness and flu-like symptoms. Nausea, diarrhea and depression are other common side effects.
Interleukin-2 is another biological therapy that is sometimes used in advanced melanoma. Other biological therapies are being tested in melanoma as part of clinical trials.
Immunotherapy is a type of treatment that encourages the body’s own immune system to fight cancer. You can find out more about immunotherapy for melanoma on the next page.
Radiotherapy
Radiotherapy uses high energy irradiation to kill cancer cells. It is given as a course of short sessions. Radiotherapy is not widely used in the treatment of melanoma, but it may be given in advanced disease to shrink tumors and help relieve symptoms. It is also sometimes used to treat the area around affected lymph nodes.
Side effects vary from one patient to another and may involve local skin reactions, a feeling of nausea and fatigue, and anemia.
