Melanoma Treatment

The proper care of melanoma requires the cooperation of many different types of physicians with expertise in a wide variety of areas, including dermatology, surgical oncology, medical oncology, radiation oncology, diagnostic radiology, pathology, and basic research scientists.

Treatment at the Center begins with an initial evaluation to determine the most appropriate plan of care. The Center’s team of specialists meets weekly to discuss each patient’s treatment plan and progress and ensure an appropriate course of treatment for each.

Treatment options offered at the Center include:

  • Wide local excision, removing approximately 1 cm of extra tissue around a skin melanoma
  • Sentinel lymph node biopsy, in which a lymph node is removed through a mini incision in order to evaluate whether melanoma has spread
  • Lymph node dissection, removal of lymph nodes to which a melanoma has spread
  • Chemotherapy and radiation treatments
  • Immunotherapy  

Surgery for Melanoma

Surgery can cure most early stage melanomas. The type of surgery needed will vary depending on the thickness of the tumor. 

  • Simple excision: fairly minor surgery to remove the tumor and a small amount of the surrounding skin. 
  • Wide excision: sometimes called re-excision, this is a secondary excision performed after a first biopsy confirms the diagnosis of melanoma, and is done to remove a larger portion of surrounding skin. 
  • Sentinel lymph node biopsy: a lymph node is removed through a mini incision in order to evaluate whether melanoma has spread 
  • Lymph node dissection: removal of lymph nodes where melanoma has spread. 
  • Surgery for metastatic melanoma: Although surgery is unlikely to be curative when melanoma has spread to other organs, it is sometimes performed to alleviate symptoms and temporarily improve a patient’s quality of life.

Chemotherapy for Melanoma

Chemotherapy is the use of medications that kill cancer cells. Chemotherapy may be administered through IV or taken in pill form. The medications travel throughout the body and attack any cancer cells that have spread.

Chemotherapy may not be curative in advanced melanoma, but it may be used to extend survival times and alleviate symptoms.

A number of chemotherapy drugs are available; these may be used alone, in combination with another chemotherapy agent, or in combination with interferon or interleukin-2. When used in combination with immunotherapy drugs, the combination may also be called chemo-immunotherapy or bio-chemotherapy.

Side effects of chemotherapy depend on the drug used, the dosage, and the length of time taken. Examples of side effects include hair loss, sores in the mouth, loss of appetite, nausea, vomiting, diarrhea, fatigue, increased risk of infection, and easy bruising. Side effects usually stop once treatment is complete. There are ways to help mitigate some of these adverse effects, such as medication to reduce nausea and vomiting.

Radiation for Melanoma

External beam radiation entails the use of high-energy rays directed at the skin to destroy cancer cells. Radiation treatment is painless and the actual treatment takes a short time, although getting in proper position for treatment takes longer.

Although radiation is not often used to treat the original melanoma, it is useful when given after surgery to prevent spread to the lymph nodes or surrounding tissues. Radiation may also be used to alleviate symptoms caused by the spread of melanoma to the brain, bones, or other areas of the body.

Biologics/Targeted Therapies for Melanoma

Biologic drugs, also called targeted therapies, are medications that block specific cellular pathways to prevent cells from growing. They work by targeting cellular changes that occur as a result of mutations to specific genes. About half of melanomas involve mutations to the BRAF gene, so patients with this gene mutation can benefit from drugs that act on this particular protein. Side effects are generally less severe with biologic therapies than with chemotherapy and immunotherapy. 

Immunotherapy for Melanoma

Immunotherapy entails administering medications that stimulate a patient’s immune system to recognize and destroy cancer cells.

Examples of immunotherapies include ipilimumab (Yervoy) and cytokines including interferon-alpha and interleukin-2 (IL2)