Melanoma Treatment

Melanoma is a type of skin cancer that often presents itself as moles, lesions, or other marks. There are a variety of different ways to treat melanoma. These range from surgical procedures to non-surgical therapies. When melanoma is treated early, it can usually be removed.

Key Facts

  • Surgery is often the preferred treatment for early-stage melanoma because it removes the entire cancerous growth. This can often be done during the biopsy.
  • If the cancer has spread beyond the skin, surgery may be combined with other medical treatments. These range from targeted therapies that attack only specific areas to more general therapies that affect the entire body. 
  • The best treatment will depend on the size and location of the melanoma, whether it has spread to other parts of the body, and the patient’s overall health.

Surgery

Surgery is the preferred treatment for small and/or early-stage melanomas. This is because it can often remove the entire cancerous area completely with little to no damage to other parts of the body. In many cases, surgery to remove a melanoma can be done during the initial biopsy.

The following are the most common types of surgery used to treat melanoma.

Wide Excision

If an excisional biopsy cannot remove an entire tumor, then doctors may recommend wide excision surgery. This is a minor procedure in which the doctor will cut out the tumor before it can grow and spread any further. This can often be done in a doctor’s office as an outpatient procedure.

The step-by-step process of a wide excision will likely resemble the following:

  1. Preparation: The area that will be removed is cleaned and disinfected.
  2. Anesthesia: A local anesthesia is injected into the area so that it is completely numb.
  3. Excision: The mole or tumor is removed, along with a thin margin of skin around it.
  4. Analysis: A small sample of the surrounding skin is analyzed under a microscope to look for cancerous cells. If some are found, a wider excision may be made or another type of treatment (such as radiation therapy) may be recommended..
  5. Closure: Once the tumor has been completely removed, the wound is stitched back together.

The risks for this type of procedure are minimal, but may include bleeding, swelling, infection, or nerve damage.

Lymph Node Dissection

If the initial biopsy reveals that the melanoma has spread beyond the skin to surrounding lymph nodes, then it may be necessary to remove the lymph nodes in that region. This helps eliminate the most likely paths for the cancer to spread, preventing it from traveling to other organs. While a lymph node dissection is a more major procedure than a wide excision, its specifics will vary depending on the number and location of lymph nodes that need to be removed.

The following is the general step-by-step process of a lymph node dissection:

  1. Preparation: The patient undergoes a final physical exam so staff can start preparing them for surgery.
  2. Anesthesia: Just before surgery, an anesthesiologist will give the patient general anesthesia. This will put them into a deep sleep for the entirety of the operation.
  3. Incision: The surgeon will begin by making an incision in order to access the infected lymph nodes. The size and location of this incision will depend on the lymph nodes that need to be removed.
  4. Removal: The regional lymph nodes are removed and sent off for analysis. The surgeon will also insert a small tube into the incision to help drain fluid from the area and speed up recovery.
  5. Closure: When all bleeding is controlled, the surgeon sews the incision closed.

After this procedure, each lymph node that was removed is analyzed for cancerous cells. This information helps doctors determine the stage of the cancer and decide if further treatment will be necessary.

Risks of lymph node dissection include infection, nerve damage, and swelling from the build up of fluid (lymphedema).

Radiation Therapy

This type of treatment directs high doses of radiation (such as x-rays) at tumors and any other affected areas in order to destroy cancerous cells. It is most often paired with surgery to lower the likelihood of the cancer coming back. But it may also be used in cases when surgery is not an option.

External Beam Radiation Therapy

While there are several different types of radiation therapy, the most common is called external beam radiation therapy. This uses a machine, placed outside the patient’s body, to send highly focused beams of radiation to a specific location. Doing this helps ensure normal healthy tissue is left alone while cancerous tissue is destroyed. 

The following is the general process for this therapy:

  1. Evaluation: A radiation oncologist determines what area to treat.
  2. Planning: A specialist called a dosimetrist takes careful measurements to figure out the best angle and most effective amount of radiation for destroying the cancer.
  3. Treatment: The patient lies down next to the machine as it administers radiation. This usually only takes a few minutes and is completely painless.

Depending on the severity of the melanoma, radiation treatments may continue for several days to several months. Common risks include fatigue, hair loss, skin irritation, and nausea. These are typically limited to where the radiation is directed and will go away after treatment.

Internal Radiation Therapy

Radiation can also be delivered internally, or from within the body. This type of treatment is not as common for melanoma, but may be used if the cancer has spread to areas of the body that would be difficult to reach using an external machine. 

There are a variety of ways to deliver radiation internally, such as needles, wires, or catheters. In general, however, surgeons will make an incision and place a radioactive substance in or near the cancer. The placement and strength of this radiation will ensure only cancerous cells are affected.

Targeted Therapy

Targeted therapy refers to drugs that are designed to attack specific parts of melanoma cancer cells. As a result, they can destroy cancerous cells while leaving other healthy cells intact. This helps increase their efficiency and reduce adverse side effects. This type of treatment might be used if the melanoma has spread to the lymph nodes or other parts of the body.

The most common types of targeted therapy drugs work by inhibiting the BRAF or MEK genes, which are often responsible for helping melanoma cancer grow. Doctors will take a cell sample to determine if a patient has one of these types of cancer. If they do, then the patient will likely take a combination of BRAF and MEK inhibitors. These usually come in pill form and are taken once or twice a day.

Some common side effects of targeted therapy drugs can include rash, fever, itching, nausea, fatigue, joint pain, and hair loss.

Immunotherapy

Immunotherapy refers to treatments that help the body’s own immune system recognize and attack cancerous cells. Normally, cancerous cells can hide from the body’s immune system by producing certain types of proteins. Immunotherapy stops this from happening. It is often paired with surgery to help ensure melanoma is completely removed from the body.

While there are several different types of immunotherapy treatments, the following two are the most common:

  • Immune Checkpoint Inhibitors: These drugs block certain proteins that would normally prevent the immune system from attacking cancerous cells.
  • Interleukin-2 (IL-2): This boosts the immune system by encouraging the production of a type of white blood cell called T-cells that can detect and destroy cancer.

Immunotherapy treatments are most often administered through intravenous (IV) infusion about once a week for about a month or more. Their risks will vary according to the treatment, but can range from mild side effects like fatigue and nausea to serious ones like low blood cell counts.

Chemotherapy

Chemotherapy is a general type of treatment that uses drugs to kill cancerous cells throughout the body. It is typically only used to treat advanced melanomas when other types of treatment have not worked. This is because it’s generally not as effective as immunotherapy and targeted therapy when it comes to treating melanoma.

There are many different types of chemotherapy drugs. They can be given intravenously, orally, or through a combination of both. Patients will often get chemotherapy treatments in cycles over several weeks in order to give their body time to rest. 

If treatment is limited to a single area, such as an arm or leg, doctors can perform isolated limb perfusion (ISP) or isolated limb infusion (ILI). These procedures separate the limb’s blood flow from the rest of the body so that the chemotherapy drugs cannot travel. This helps make them more effective and reduces their effects on the rest of the body.

Chemotherapy can cause numerous side effects, such as fatigue, nausea, hair loss, bruising or bleeding, loss of appetite, and more. These symptoms will go away when treatment is complete.

Next Steps

The Melanoma Center gives every patient access to a full range of treatment options according to their needs. Our multidisciplinary team can help personalize your treatment plan and create a comprehensive follow-up program to lower the chances of recurrence. For those with advanced melanoma, we also offer cutting-edge treatments, such as IL-2 immunotherapy, that can further your fight against cancer.

Call us at (212) 305-9676 to schedule an appointment, or you can fill out our appointment request form.