Skin Cancer, Melanoma
Treatment Overview
Surgical removal (excision) of the affected skin is the most effective treatment for melanoma. Excision involves removing the entire melanoma along with a border (margin) of normal-appearing skin. Additional treatment may be needed based on the stage of the melanoma.
Staging for treatment of melanoma
Staging is a method of describing how far a cancer has progressed. It is done after excision of the melanoma and assessment of lymph nodes and other parts of the body to determine whether the cancer has spread. Staging helps doctors determine the best possible treatment. Staging evaluates:6
- Tumor thickness and depth.
- Ulceration of skin over the melanoma.
Initial treatment
Melanoma may be cured if caught and treated in its early stages when it affects only the skin. If melanoma is confined to the skin (primary melanoma), you will have surgery to remove the affected skin. If the melanoma is thin and has not invaded surrounding tissues, excision may cure the melanoma. In more advanced stages, melanoma may spread, or metastasize, to other organs and bones, making cure less likely.
Initial treatment will depend on the stage of the melanoma.8, 9
- Stage 0 melanoma or melanoma in situ invades only the outer layer of skin. Surgery to remove the lesion or mole is usually all that is needed.
- Stage I melanoma is generally less than 1 mm (0.04 in.) thick. Surgery to remove the cancer is usually all that is needed. Some advanced stage I melanomas may be treated like stage II.
- Stage II melanoma is more than 1 mm (0.04 in.) thick, but does not spread to the lymph nodes. Surgery to remove the cancer is most common. Other treatments your doctor may consider are a lymph node biopsy, a medicine called interferon, observation, or enrolling you in a clinical trial. Reconstructive surgery may be needed to repair the scar left by surgery, especially if it is on the face or hands. Some advanced stage II melanomas may be treated like stage III.
- Stage III melanoma has spread to the lymph nodes. Treatment includes surgery to remove the primary melanoma and all of the lymph nodes near the primary melanoma. This is usually followed by immunotherapy with interferon. Interferon is a protein similar to proteins made by the white blood cells. These proteins act in two ways—by weakening or killing cancer cells and also by boosting the body's immune system to fight the cancer. Your doctor may also talk to you about enrollment in a clinical trial.
- Stage IV melanoma is cancer that has spread far from the initial cancer site, perhaps to the liver, brain, or bones. Treatment may include surgery, radiation, chemotherapy, or immunotherapy with drugs such as interferon. Most treatment in stage IV is to treat the symptoms caused when the cancer spreads to other areas, such as bone pain if the cancer spreads to the bone.
Treatment for melanoma that develops in other places in the body depends on the site. Sites can include:
- The eye (ocular melanoma). In the past, melanoma of the eye often required removal of the eyeball (enucleation). Sometimes it is still necessary to remove the eye, but there are now alternative treatments for some of these cases. Treatment may include radiation, laser treatment called photocoagulation to seal off the blood supply to the cancer, and surgeries that do not remove the entire eyeball.10
- The skin of a finger or toe or under a nail. Melanoma in these sites is treated by removing (excising) diseased tissue. Often the entire finger or toe will have to be removed.3
Ongoing treatment
Regular follow-up appointments are important once you have been diagnosed with melanoma.11 After surgery to remove melanoma, you will have follow-up appointments every 3 to 6 months for 5 years, then annually. You will continue to have follow-up appointments every 3 to 6 months if you have:
- Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous, but their presence is a warning of an inherited tendency to develop melanoma.
- Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to get melanoma.
Treatment if the condition gets worse
Swollen or tender lymph nodes may be a sign that the melanoma has spread. Any enlarged regional lymph nodes should be removed and checked for melanoma.
Stage IV (metastatic) melanoma responds poorly to most forms of treatment. The 5-year survival rate for stage IV melanoma is less than 50%.11 The goal of treatment of metastatic melanoma is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Metastatic melanoma may be treated with:
- Surgery.
- Radiation therapy.
- Chemotherapy with dacarbazine (DTIC). The main side effect from DTIC is nausea and vomiting, which usually can be controlled with antinausea medicines. Another drug called temozolomide is being studied for treating melanoma. Temozolomide may be used to treat cancer that has spread (metastasized) to the brain.
- Immunotherapy with drugs such as interferon.
If you have metastatic melanoma, you may wish to participate in a clinical trial. Check with your doctor to determine whether clinical trials are available in your area.
What To Think About
After removal of a primary melanoma, a skin graft or other reconstructive surgery may be needed for cosmetic reasons or to restore function. This is most likely if the melanoma was large or was a late-stage tumor.
Melanoma can come back after treatment. Learn to do a skin self-exam and to check for swelling in your lymph nodes, and report any changes to your health professional.11 It's a good idea to get in the habit of doing this skin and lymph-node check at the same time every month.
There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to cancer. If your reaction interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.
End-of-life issues
If you have advanced (metastatic) melanoma, you may choose to stop curative treatment and focus on care that assures your comfort (palliative care). Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to palliative care is difficult. For more information, see the following topics:
 Go to previous section |  Go to top of page |  Go to next section |
| Author: | Shannon Erstad, MBA/MPH | Last Updated: January 11, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Randall D. Burr, MD - Dermatology | |
 | ||
