Skin Cancer, Melanoma

Medications

Interferon given before or after surgery (adjuvant therapy) is standard treatment for melanoma that has spread to the lymph nodes. The use of interferon may increase the survival rate of some people with stage IIB and stage III melanoma.¹¹

Melanoma that has spread to distant sites is rarely curable with standard treatment, although several medicines are being studied in clinical trials.

Chemotherapy generally does not increase survival rates for metastatic melanoma. But the chemotherapy medicine dacarbazine (DTIC) may be used for palliative treatment of stage IV (metastatic) melanoma.

Medication Choices

Medicine treatment for melanoma that has metastasized may include:

• Interferon, which may be used for any melanoma thicker than about 1 mm (0.04 in). It is commonly used if melanoma has spread to the lymph nodes. Interferon can make cancer cells too weak to protect themselves from the body's immune system. Research shows that interferon can extend the period of time between initial treatment and relapse. Some studies also suggest it can lead to longer life for some people.¹¹
• Dacarbazine (DTIC), which may be used for the treatment of stage IV (metastatic) melanoma. The main side effect from DTIC is nausea and vomiting, which usually can be controlled with antinausea medicines. Your doctor will prescribe medicines to be taken with your treatments and when you get home to help relieve any nausea that you may have. These medicines may include:
  • Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program.
  • Dimenhydrinate (Dramamine), which is often used to treat motion sickness. It relieves nausea by blocking motion signals to the brain.
  • Metoclopramide (Reglan), which increases the movements or contractions of the stomach and intestines. This decreases the amount of time it takes for the stomach contents to move through the digestive tract.
  • Phenothiazines, such as promethazine or prochlorperazine. These medicines stop nausea and vomiting by reducing the activity of the central nervous system.
  • Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These medicines work by blocking the effects of a chemical (serotonin) produced in the brain and in the stomach that controls vomiting. They are often more effective when they are combined with corticosteroids, such as dexamethasone, which reduce swelling in the part of the brain that controls nausea.
• Temozolomide (Temodar) is a drug that can reach the brain, so it is sometimes used to treat melanoma that has spread (metastasized) to the brain.

What To Think About

New forms of chemotherapy are constantly being tested. The success of new medicines and new medicine combinations is determined by clinical trials. Check with your doctor to find out whether clinical trials are available in your area.

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Author:	Bets Davis, MFA	Last Updated: December 5, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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