Treatments

Early stages of melanoma—melanoma that has not spread—can typically be treated with surgery to remove the cancerous cells and some surrounding tissue. Cancer that has spread to nearby lymph nodes may require the removal of the lymph nodes as well.

For cancer that has spread to other organs, treatment is more challenging. Melanoma is usually not curable at this point, and treatment becomes directed at shrinking the tumor and improving symptoms. However, there are always new discoveries and advances in treatment aimed at curing more serious cases of melanoma.

Treatment options include:

  • surgery
  • chemotherapy
  • immunotherapy
  • radiation therapy
  • sentinel lymph node biopsy (SLNB)

Surgery

Surgery is often the first step toward treating melanoma. It can involve removal of the tumor, or may require additional removal of some of the surrounding area. Once the cancerous cells have been removed, no further treatment may be necessary. In many cases, the procedure for thinner melanoma can be performed in a doctor’s office, or as an outpatient procedure. Excision, which can be done in a doctor’s office, involves a numbing of the affected area followed by a surgical excision to remove the melanoma.

Chemotherapy

Chemotherapy is often used as an additional method of treatment following surgery in more advanced cases of melanoma. Administered either orally, topically, or through a vein, chemotherapy drugs kill cancer cells.

Chemotherapy is applied in cycles, staggered between periods of rest. The American Cancer Society points out that chemotherapy is less effective for melanoma than for other types of cancer. However, the treatment may help relieve some symptoms in advanced cases of the disease.

Due to the fact that chemotherapy kills cancer cells as well as normal cells, there may be side effects, including:

  • hair loss
  • nausea/vomiting
  • loss of appetite
  • fatigue
  • diarrhea
  • easy bruising (from low blood platelets)
  • increased chance of infection

Ongoing studies continue as to the benefits of anti-angiogenic drugs, a class of drugs designed to prevent new blood vessels from forming, therefore cutting the supply from be able to nourish cancer cells. Still considered experimental, these drugs could show promising efforts at combating melanoma.

Immunotherapy (Biologic Therapy)

Immunotherapy involves the use of protein-based medications, such as interferon, to boost the immune system, and may be used in combination with other treatments. For example, in patients with thicker melanomas, the cancer cells may appear to have been completely removed by surgery but still remain in small traces. To ensure that cancer cells don’t spread, an injection of proteins that boost the immune system is used to prevent any remaining cells from growing. 

Radiation Therapy

Radiation therapy is rarely used on the original tumor, but is instead directed more often on the nearby lymph nodes, following surgery, to prevent the return of the cancer. This form of treatment is also used to relieve painful symptoms due to the spread of cancer in the body. Side effects may include fatigue, nausea, and vomiting, and typically end once treatment is completed.

Sentinel Lymph Node Biopsy (SLNB)

Early detection of melanoma is crucial in curing the disease. Once melanoma has spread to the lymph nodes or other organs, it is much harder to treat. Before the 1990s—and the introduction of the sentinel lymph node biopsy (SLNB)—patients had two options: complete lymph node removal, or observing an anxious “wait and see” period. The first option posed some serious health problems. Complications like tissue swelling and numbness were a potential side effect of entirely removing the lymph nodes—an unnecessary procedure for many patients. The number of patients actually requiring complete lymph node removal remained relatively low, accounting for “only 20 percent of melanoma patients,” according to the National Cancer Institute (NCI). The second option, it goes without saying, was not very popular either.  

Innovation led to the SLNB, introduced by Dr. Donald Morton of the John Wayne Cancer Institute (JWCI). This new procedure allowed doctors to examine the sentinel nodes to determine the next course of action. As NCI reports, based on findings from Dr. Morton’s 1992 study, “only if the sentinel nodes are found to be cancerous are all the nearby lymph nodes removed.” While much remains to be learned, this new technology took strides in diagnosing stages of melanoma and designing a treatment plan. By identifying and removing the sentinel nodes in patients, doctors could then establish if all the lymph nodes needed to be removed. Results from a follow-up study by JWCI appeared in The New England Journal of Medicine in September 2006. Researchers stated that SLNB offered a valuable method in determining if melanoma had spread to the lymph nodes, leading to significantly improved survival rates in patients.