Treatment
How Is Melanoma Skin Cancer Treated?
This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.
About treatment
Once melanoma has been found and staged, your cancer care team will recommend treatment options. They may include one or more of the following:
* Surgery
* Chemotherapy
* Immunotherapy
* Radiation therapy
Think about your choices without feeling rushed. If there is anything that’s not clear, ask to have it explained. The best choice depends mostly on the thickness of the tumor and the stage of the disease.
Types of surgery for melanoma
Surgery is the main treatment for most cases of melanoma. It can often cure early stage melanomas.
Simple excision
Thin melanomas can be cured by a fairly minor operation called simple excision. After the skin is numbed, the tumor is cut out, along with a small amount of normal skin at the edges (called the margin). The wound is then stitched closed. This surgery will leave a scar.
Wide-excision (re-excision)
If melanoma was confirmed by biopsy, the area will need to be excised (removed) again. More skin will be cut away from the area around the melanoma and the tissue will be looked at under a microscope to make sure that no cancer cells are left in the skin. If the cancer is on the face, a smaller amount of tissue may be removed. A method called Mohs surgery may be used. In this surgery the cancer is removed layer by layer until the tissue shows no signs of cancer. But not all doctors agree on the use of Mohs surgery for melanoma.
Amputation
If the melanoma is on a finger or toe, the treatment may mean removing all or part of that finger or toe (amputation). At one time, some melanomas of the arms and legs were also treated by amputation, but this is no longer done. Studies have shown that wide excision works as well as amputation in these cases.
Lymph node dissection
Once a diagnosis of melanoma has been made, the doctor will check the lymph nodes nearest the cancer. If the nodes are not swollen, then a sentinel node biopsy may be done. If the sentinel node does not show cancer, then the disease has most likely not spread to other nodes and there is no need to remove lymph nodes. (See the section “How is melanoma found?” for a description of sentinel lymph node biopsy.)
If the sentinel lymph node does show cancer, then the other nodes in that area might be removed. But right now doctors do not know whether finding and taking out lymph nodes that may have cancer cells really helps save lives. Still, many surgeons are doing a sentinel node biopsy because it does help to figure out a patient’s outlook. If the nodes feel very hard or large, and the FNA biopsy shows that the cancer has spread, then the nodes are usually removed.
Removing lymph nodes can cause some long-term side effects. The most troublesome is called lymphedema. Lymph nodes help drain fluid from the arms and legs. If the lymph nodes are removed, fluid can build up, leading to limb swelling. This side effect, along with the discomfort of the surgery itself, is the reason lymph nodes are not removed unless the doctor thinks it’s necessary.
Surgery for melanoma that has spread
When the melanoma has spread from the skin to distant organs (such as the lungs or brain), the cancer is very unlikely to be cured by surgery. Even so, surgery is sometimes done because removing even a few areas of spread could help some people to live longer or have a better quality of life.
Chemotherapy
Chemotherapy (“chemo”) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Chemo is useful in treating cancer that has spread.
While chemo drugs kill cancer cells, they also damage some normal cells. This can lead to side effects. These side effects will depend on the type of drugs used, the amount taken, and the length of treatment. Short-term side effects might be:
* Hair loss
* Mouth sores
* Loss of appetite
* Nausea and vomiting
* Increased chance of infection (due to low white blood cell counts)
* Easy bruising or bleeding (due to low blood platelets)
* Tiredness (due to low red blood cells)
Most side effects go away once treatment is over. There are ways to lessen many of the side effects, so be sure to tell your doctor or nurse if you are having any of these problems.
Several types of chemo can be used to treat advanced melanoma. Chemo does not usually work as well for melanoma as it does for some other types of cancer, but it may relieve symptoms or help people with advanced disease live longer. Some studies suggest that using several drugs with one or more immunotherapy drugs may work better than using just one drug, but it’s not clear if this helps people live longer.
Isolated limb perfusion is a type of chemo sometimes used for treating melanomas on the arms or legs. This treatment separates the blood flow of the limb with cancer from the rest of the body for a short time. High doses of chemo are then put into an artery of the limb. This allows high doses to be given to the area of the tumor without exposing the whole body to it, which would cause bad side effects.
Immunotherapy
Immunotherapy helps boost a person’s immune system to better attack the cancer. There are many types of immunotherapy used for people with advanced melanoma.
Cytokines
Cytokines are proteins that “turn on” the immune system. They can help shrink stage III and IV melanomas in about 10% to 20% of patients. Side effects may include flu-like symptoms like fever, chills, aches, and severe tiredness. One drug used can cause fluid to build up in the body so that the person swells up and can feel quite sick.
Interferon-alpha
Patients with deeper melanomas often have cancer cells that travel to other parts of the body. Even after it looks as if all the cancer has been removed, some of these cells may remain. Interferon-alpha can be used as an added (adjuvant) therapy after surgery to help prevent these cells from spreading and growing. This treatment might help keep the melanoma from coming back quickly. But it is not yet clear if adjuvant interferon improves survival.
In order to work, though, high doses of interferon must be used. Many patients can’t take the side effects of these high doses. Side effects may be fever, chills, aches, severe tiredness, and effects on the heart and liver. Patients having this treatment should be closely watched by a cancer doctor (oncologist) who has experience with this treatment.
Melanoma vaccines
Weakened melanoma cells (or certain substances found in these cells) can be given to a patient to try to make the body’s immune system kill the cancer cells. This is something like the way we use vaccines to destroy viruses that cause polio, measles, and mumps. But making a vaccine against a tumor like melanoma is harder than making a vaccine to fight a virus. Clinical trials are going on to test the value of treating people with advanced melanoma with vaccines, sometimes combined with cytokine therapy as well. The results of these studies have been mixed so far, but newer vaccines may hold more promise.
BCG (Bacille Calmette-Guerin) vaccine
BCG is a bacterium related to the germ that causes tuberculosis (Tb). Unlike its bacterial “cousin,” BCG does not cause serious disease in humans, but it does “turn on” the immune system. It is sometimes used to help treat stage III melanomas. It is given as a shot (injection) right into the tumors.
Imiquimod cream
Imiquimod is a drug that, when used as a cream, causes an immune response against skin cancer cells. For very early (stage 0) melanomas in sensitive areas on the face that may be disfigured by surgery, some doctors may use imiquimod. The cream is used anywhere from once a day to 2 times a week for around 3 months. Some people may have serious skin reactions to this drug. Not all doctors agree on whether it should be used for melanoma. Imiquimod is not used for more advanced melanomas.
Radiation therapy
Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells or shrink tumors. External beam radiation focuses radiation from outside the body on the skin tumor. The treatment is much like getting an x-ray, but the radiation is more intense. The treatment itself is painless. Each treatment lasts only a few minutes, but the setup time — getting you into place for treatment — usually takes longer.
Radiation therapy is not often used to treat the original tumor that started on the skin. But it may be used to treat cancer that has come back, either in the skin or lymph nodes, if the cancer cannot all be removed by surgery. It may also be used to treat distant spread or to relieve symptoms of cancer that has spread to the brain or the bone. Radiation therapy used this way is not meant to cure the cancer, but it may help shrink it for a time to control some of the symptoms.
Clinical Trials
You may have had to make a lot of decisions since you’ve been told you have cancer. One of the most important decisions you will make is choosing which treatment is best for you. You might have heard about clinical trials being done for your type of cancer. Or maybe someone on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. They are done to get a closer look at promising new treatments or procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691 or on our Web site at http://clinicaltrials.cancer.org. You can also get a list of current clinical trials by calling the National Cancer Institute’s Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.
There are requirements you must meet to take part in any clinical trial. If you do qualify for a clinical trial, it is up to you whether or not to enter (enroll in) it.
Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
Complementary and Alternative Therapies
When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn’t mentioned. Everyone from friends and family to Internet groups and Web sites offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
What exactly are complementary and alternative therapies?
Not everyone uses these terms the same way, and they are used to refer to many different methods, so it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment.
Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not be helpful, and a few have even been found harmful.
Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.
Finding out more
It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.
As you consider your options, here are 3 important steps you can take:
* Look for “red flags” that suggest fraud. Does the method promise to cure all or most cancers? Are you told not to have regular medical treatments? Is the treatment a “secret” that requires you to visit certain providers or travel to another country?
* Talk to your doctor or nurse about any method you are thinking about using.
* Contact us at 1-800-227-2345 to learn more about complementary and alternative methods in general and to find out about the specific methods you are looking at.
The choice is yours
Decisions about how to treat or manage your cancer are always yours to make. If you want to use a non-standard treatment, learn all you can about the method and talk to your doctor about it. With good information and the support of your health care team, you may be able to safely use the methods that can help you while avoiding those that could be harmful.