Melanoma

Treatment

Treatment for melanoma depends on the extent of the disease, the patient’s age and general health, and other factors. People with melanoma are often treated by a team of specialists includes a dermatologist, surgeon, medical oncologist, radiation oncologist and plastic surgeon.

The treatment options are surgery, chemotherapy, biological therapy and radiation therapy. Sometimes a combination of these therapies are used.

Surgery :
Surgery is the usual treatment for melanoma. In this procedure, the surgeon removes the tumor and some normal tissue around it. In some cases surgery may not be necessary, because the doctor may be able to completely remove a very thin melanoma during the biopsy. In most cases, additional surgery is performed to remove normal-looking tissue around the tumor (called the margin) to make sure all melanoma cells are removed. If a large area of tissue is removed, the surgeon may do a skin graft. For this procedure, the doctor uses skin from another part of the body to replace the skin that was removed.

If cancer cells are spread through the lymphatic system, the lymph nodes has to be removed. Sentinel lymph node biopsy and Lymph node dissection are the two methods used for this.

Sentinel lymph node biopsy - This is the removal and examination of the sentinel node and is done after the biopsy of the melanoma but before the wider excision of the tumor. To identify the sentinel lymph node, a radioactive substance is injected near the tumor. The surgeon follows the movement of the substance on a computer screen. The first lymph node to take up the substance is called the sentinel lymph node. The surgeon then removes the sentinel node to check for the presence of cancer cells. (The imaging study is called lymphoscintigraphy. The procedure to identify the sentinel node is called sentinel lymph node mapping.) If a sentinel node contains cancer cells, the surgeon removes the rest of the lymph nodes in the area. However, if a sentinel node does not contain cancer cells, no additional lymph nodes are removed.
Lymph node dissection - Also called lymphadenectomy, it is a surgical procedure in which the lymph nodes are removed and examined for cancer cell. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.

Side Effects : The side effects of surgery depend mainly on the size and location of the tumor and the extent of the operation. The side effects are weakness, pain and scarring Sometimes surgery is not effective in controlling melanoma that has spread to other parts of the body. In such cases adjuvant therapy is given. It is the treatment given after the primary treatment to increase the chances of a cure and this may include chemotherapy, radiation therapy, hormone therapy or biological therapy or a combination of these methods.