Melanoma is not a “one-size-fits-all” cancer. There are several types of melanoma, each of which present different molecular and cellular changes, treatment options and prognosis.
At Banner MD Anderson Cancer Center, we take a multidisciplinary approach to melanoma treatment to ensure patients receive the most advanced therapies with the least impact to the body as possible. Our robust team of medical, surgical and radiation oncologists, plastic surgeons, radiologists and pathologists works together to develop individualized treatment plans based on the unique needs of each patient. Clinical nurse navigators work closely with patients, guiding them through the treatment process.
We offer several innovative treatments for melanoma, including:
If melanoma is caught early, it is highly treatable. Surgery is the main treatment for early melanomas, and it may be used as part of the treatment approach for more advanced melanomas.
The type of surgery used to treat melanoma depends on the thickness of the melanoma tumor, whether it has spread, and the specific type of melanoma:
- Melanomas Less Than 1 Millimeter Thick
The most commonly performed procedure is a wide excision of the primary tumor. The surgeon carefully cuts out the melanoma and a predetermined area around it. The amount of skin that is removed and the degree of scarring depend on the thickness of the melanoma tumor. Most patients usually do not need more treatment.
Depending on the melanoma size, the local excision may be an in hospital or outpatient procedure, often with local anesthesia. Stitches may be required, and recovery can take a few weeks. Severity of the scar depends on the size, depth and location of the melanoma.
Based on how aggressive the melanoma looks under the microscope, your surgeon may discuss a procedure called lymphatic mapping and sentinel lymph node biopsy, a minimally invasive surgical approach in which the regional lymph node(s) that receive lymph drainage from the primary tumor site is/are removed and carefully checked for cancer spread to the regional nodes. These “sentinel” lymph nodes represent the most likely nodes to contain spread, if any are involved. If the sentinel lymph node is cancer free, then the other lymph nodes do not need to be checked or removed. If the sentinel lymph node contains melanoma spread (metastasis), your doctor may discuss further surgery and other treatment.
- Melanomas More Than 1 Millimeter Thick
The principal procedure is a wide excision of the primary tumor. The surgeon carefully cuts out the melanoma and a predetermined area around it. The amount of skin that is removed and the degree of scarring depend on the tumor thickness of the melanoma. Most patients usually do not need more treatment.
If a large area of skin is removed during surgery, a skin graft may be done to reduce scarring. The surgeon numbs and removes a patch of healthy skin from another part of the body, such as the upper thigh, and then uses it to replace the skin that was removed. If you have a skin graft, you may need to take special care of the area until it heals.
In addition to a wide excision, your melanoma surgical oncologist will discuss a procedure called lymphatic mapping and sentinel lymph node biopsy, a minimally invasive surgical approach in which the regional lymph node(s) that receive lymph drainage from the primary tumor site is/are removed and carefully checked for cancer spread to the regional nodes. These “sentinel” lymph nodes represent the most likely nodes to contain spread, if any are involved. If the sentinel lymph node is cancer free, then the other lymph nodes do not need to be checked or removed. If the sentinel lymph node contains melanoma spread (metastasis), your doctor may discuss further surgery and other treatment such as immunotherapy
Regional Lymph Node Metastasis
If melanoma has spread to the regional lymph nodes, a surgical procedure known as lymph node dissection (also termed lymphadenectomy) is often performed. This procedure consists of removal of the “compartment” of lymph nodes related to the location of where the tumor-containing lymph node was identified. This procedure is performed under general anesthesia; one or more drain tubes are usually placed at the completion of surgery to facilitate recovery. Lymph node dissection has been linked to certain long-term side effects, including lymphedema, which may result in fluid buildup in the arms or legs.
Depending on the extent of spread to the lymph nodes, radiation therapy may also be recommended to try to reduce the chance of the melanoma recurring in the regional nodes. Immunotherapy may also be recommended.
- Metastatic Melanoma (Stage IV)
Surgery may sometimes be used to treat melanoma that has spread to distant parts of the body.
Chemotherapy (“chemo”) uses drugs that travel through the bloodstream to attack cancer cells that have spread to the lymph nodes and other organs. It is most commonly used in cases of advanced melanoma. The specific drugs used are determined by the stage of the cancer as well as features unique to the patient and his or her overall health. Chemotherapy, which may be used alone or in conjunction with other treatment approaches such as surgery or radiation therapy, is administered in cycles with a period of rest between each to allow the body to recover.
The most common chemotherapy drugs used to treat melanoma, which may be given individually, in combination or as part of a greater treatment plan, include:
- Dacarbazine (also called DTIC)
Immunotherapy centers on stimulating the immune system to fight advanced melanoma through the use of various drugs, including:
- Ipilimumab, a protein that helps keep immune system cells called T cells more active. It has proven effective in patients with advanced melanoma who are not candidates for surgery. However, it can lead to serious side effects related to an overstimulated immune system attacking other parts of the body.
- Cytokines, proteins that provide a general boost to the immune system by helping to shrink advanced (stage III and IV) melanomas. Two versions of natural cytokines used in melanoma treatment are interferon-alpha and interleukin-2 (IL-2). These drugs may also be used in combination with chemotherapy for a treatment technique known as biochemotherapy.
- Interferon-alpha, a drug that often serves as an adjuvant or supplemental therapy for patients with thicker melanomas or when the disease has spread to the lymph nodes. It is sometimes used as a follow up to surgery to prevent lingering cancer cells that could not be surgically removed from spreading and growing.
Radiation therapy is a quick and painless procedure that uses high-energy rays to kill cancer cells. In treatment for melanoma, it centers on the use of external beam radiation, which is radiation delivered from outside the body onto the skin tumor, to treat the original melanoma that started on the skin. However, it may also be used in combination with surgery to help minimize the chances of recurrence, to treat melanoma that has returned, or in palliative care to relieve symptoms caused by metastases to the brain to help shrink the cancer and control symptoms.
Targeted therapy uses drugs that target specific molecules involved in the growth and progression of melanoma. These innovative treatments are designed to take advantage of a new understanding of the molecular alterations that sometimes occur within melanoma tumor cells. Treatment may include:
- B-RAF inhibitors
- KIT inhibitors
- Other treatments in clinical trial
Increased understanding of gene changes in melanoma cells has led to the development of drugs that are specifically designed to attack these changes. Unlike chemotherapy, targeted drugs generally have less severe side effects and may work when chemotherapy has proven ineffective.
Targeted therapies for the BRAF gene
Nearly half of all melanomas involve mutations in the BRAF gene that cause it to make an altered protein that prompts melanoma cells to grow and divide. Drugs that target these gene mutations have shown to shrink melanoma tumors in about half of patients and prolong life by delaying future tumor growth.
Targeted therapies for the C-KIT gene
Different gene changes have been linked to other types of melanoma, including those that start in specific areas of the body such as:
- On the palms of the hands, soles of the feet or under fingernails
- Inside the mouth or other mucosal areas
- In areas that get chronic sun exposure
Cell changes in the C-KIT gene are evident in approximately one-third of these uncommon melanomas. While other drugs targeting C-KIT cell changes are currently in use, clinical trials continue to evaluate their efficacy in treating melanoma.
Targeted therapies for other gene or protein changes
In the quest to identify new melanoma treatment therapies, clinical trials continue to evaluate the efficacy of drugs that target abnormal genes and proteins. Similarly, studies are underway to assess the potential risks and benefits of combining these targeted drugs with such treatments as chemotherapy and immunotherapy.
The National Cancer Institute (NCI) is a trusted resource for additional information about melanoma treatment options and guidelines for physicians.
Choosing the best treatment option is one of the most important decisions in a person’s cancer journey. Depending on the type of cancer, staging and other health factors, participation in a clinical trial to receive the latest treatment therapies may be possible.
These carefully controlled and highly regulated research studies are dependent upon patients who voluntarily participate and help provide a closer look at promising new treatment techniques.
Clinical trials at Banner MD Anderson Cancer Center are conducted in accordance with the National Cancer Institute. Speak with your doctor to learn more about clinical trials currently underway, eligibility requirements and other participation guidelines.