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.

Chemotherapy :
Chemotherapy which is the method of using drugs to kill cancer cells is sometimes used to treat melanoma. They are usually given through injection, but some may be given by mouth. These drugs enter the bloodstream and can affect cancer cells throughout the body.

Isolated limb perfusion or Isolated arterial perfusion - For melanoma on an arm or leg, chemotherapy drugs are put directly into the bloodstream of that limb. The flow of blood to and from the limb is stopped for a while. This allows most of the drug to reach the tumor directly. Most of the chemotherapy remains in that limb.
Hyperthermic perfusion - Chemotherapy in which drugs are heated before injection is called hyperthermic perfusion. In this procedure, a warmed solution containing anticancer drugs is used to bathe or is passed through the blood vessels of the tissue or organ containing the tumor.

Side Effects : Drugs used in chemotherapy can damage some normal cells, causing side effects. These side effects depend on the specific drugs and the dose. Chemotherapy can affect the blood cells, causing bruise or bleed and the patients are likely to get infections. Other possible side effects are hair loss, tiredness, poor appetite, nausea, vomiting, diarrhea, or mouth and lip sores. Most side effects can be controlled with drugs.

Biological Therapy :
Biological therapy or immunotherapy uses the body's natural ability to fight cancer and helps to prevent the cancer from coming back. Biological therapy for melanoma uses substances called cytokines. The body normally produces cytokines in small amounts in response to infections and other diseases. It can also be produced in the laboratory by recombinant DNA technology. In some cases, biological therapy given after surgery can help prevent melanoma from recurring. For patients with metastatic melanoma or a high risk of recurrence, interferon alpha and interleukin-2 (also called IL-2 or aldesleukin) may be recommended after surgery.

Side Effects : The side effects of biological therapy differ with the types of substances used and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur. Other side effects are fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea.

Radiation Therapy :
Radiation therapy alias radiotherapy is the treatment using a beam of high-energy rays or particles to destroy cancer cells. It may be used to help control melanoma that has spread to the brain, bones, and other parts of the body. It may shrink the tumor and relieve symptoms. The radiation may come from outside the body (external radiation) or from radioactive materials placed into or next to the tumor (internal radiation).

Side Effects : Radiation can cause the scalp or the skin in the treated area to become red, dry, tender, and itchy. The side effects of radiation therapy depend on the amount of radiation given and the area being treated. It can cause tiredness, hair loss, nausea, fatigue, vomiting, and loss of appetite. Most side effects will be disappear after treatment but some may be last.

After Treatment :

Melanoma patients have a high risk of developing new melanomas. Some are at risk of a recurrence of the original melanoma in nearby skin or in other parts of the body. Regular follow-up exams are very important after treatment. Patients should continue to have regular checkups and examine their skin monthly. They should follow their doctor’s advice about how to reduce their chance of developing another melanoma. Checkups usually include careful physical exam, blood tests, x-rays and scans of the chest, liver, bones and brain.