Melanoma Treatments, Side Effects and Support

The multidisciplinary team at Banner MD Anderson Cancer Center delivers some of the most advanced treatments to patients with melanoma. Medical, surgical and radiation oncologists, plastic surgeons, radiologists, dermatologists, and pathologists all work together to develop an individualized melanoma treatment plan to meet your specific needs.

How Is Melanoma Treated?

Based on the stage of your cancer and other factors, your treatment options might include:

Surgery for Melanoma

Surgery is the main treatment for melanoma and usually it can cure the cancer in its early stages. For more advanced melanoma, surgery may be combined with other therapies.

• Wide excision: A common surgical procedure for melanoma is a wide excision. A surgeon carefully cuts out the melanoma and some normal skin around it. It’s usually done as an outpatient procedure. You may need stitches, staples or a skin graft, and it can take a couple weeks to heal. The amount of scarring depends on the size of the incision. If you have a skin graft, take special care of the donor area until it heals as well.
• Sentinel lymph node biopsy: For thicker melanomas, your surgeon may do a minimally invasive surgical approach called lymphatic mapping and sentinel lymph node biopsy. Lymphatics are fluid channels in your skin that drain to small glands call lymph nodes. Lymph nodes near the primary tumor site are removed and carefully checked for cancer. These “sentinel” lymph nodes are the first draining lymph nodes for the part of the skin where the melanoma is located. If the melanoma were to spread, these lymph nodes are the most likely location the melanoma would spread. If the sentinel lymph nodes are cancer-free, then the other lymph nodes may not need to be checked or removed. If the sentinel lymph nodes contain melanoma, your doctor will discuss further surgery or other medical treatments.
• Regional lymph node metastasis: If melanoma has spread to regional lymph nodes, your doctor may recommend a lymph node dissection (lymphadenectomy). A “compartment” or group of lymph nodes likely affected by the cancer is surgically removed. This procedure is performed under general anesthesia. Drain tubes are placed to facilitate recovery, which takes several weeks. Depending on the cancer’s spread, radiation therapy and/or immunotherapy also may be recommended. A possible side effect of lymph node dissection is lymphedema, which causes fluid to pool in the arms or legs. Other times, surgery may not be recommended but immunotherapy (a treatment that uses your own immune system to fight cancer cells) may be offered.
• Metastatic melanoma (stage IV): Surgery may be used to treat melanoma that has spread to distant parts of the body. However, melanoma that has metastasized is very unlikely to be cured by surgery. In these circumstances, surgery may be performed to help with symptoms such as pain or bleeding. On rare occasions, surgery may be performed in order to achieve a cancer free state and possible cure.

Recovery from Melanoma Surgery

Most wounds take one to three weeks to heal. If you have a skin graft, healing may take longer. Some soreness around the wound is normal, and taking over-the-counter pain medicine can help.

Common side effects of melanoma surgery: Infection, fluid buildup under the scar or at the sight where the lymph node was removed, problems with wound healing, numbness or tingling, pain, blood clots and scarring

Immunotherapy for Melanoma

Immunotherapy uses drugs to stimulate your immune system and fight melanoma. It boosts your body’s natural defenses using materials made in your body or a lab to improve, target or restore immune system function. Immunotherapy has become the initial treatment once melanoma has spread  to other sights in the body (lymph nodes or distant locations). Although immunotherapy can be effective in treating melanoma, there are possible side effects.

Common side effects of immunotherapy: Skin reactions, flu-like symptoms, diarrhea, hormonal imbalances including thyroid and adrenal gland and weight changes

Targeted Therapies for Melanoma

Targeted therapy uses drugs to target specific mutations or pathways in the cancer, blocking its growth and spread, while limiting damage to healthy cells. Types of targeted therapies for melanoma may include: B-RAF inhibitors, KIT inhibitors, MEK inhibitors and others. Targeted therapy usually has less severe side effects than other treatments but only patients with specific mutations in their tumor can receive targeted therapy.

Common side effects of targeted therapy: Rash, nausea, diarrhea, swelling and sensitivity to sunlight

Chemotherapy for Melanoma

Chemotherapy for melanoma is rarely used for metastatic melanoma. It may be considered when both immunotherapy and targeted therapy are not effective.  Chemotherapy drugs attack cancer cells through the bloodstream. It’s most used in advanced melanoma and sometimes in conjunction with other treatments. Chemotherapy does have side effects, and these usually go away after treatment is finished.

Common side effects of chemotherapy: Fatigue, infection, nausea, vomiting, nail changes, loss of appetite, diarrhea, nerve damage and hair loss

Radiation Therapy for Melanoma

Radiation therapy uses high-energy x-rays to kill cancer cells. Melanoma treatment uses external-beam radiation therapy, which is given from outside the body and blocks non-cancer areas, decreasing side effects. Radiation for melanoma is usually considered for hard to treat areas or recurrent disease.  Sometimes radiation therapy is used in combination with other treatments to reduce cancer size or prevent it from coming back. Radiation therapy side effects are generally mild, can be treated with over-the-counter medicines and go away after treatment is finished but can have lasting effects to the skin and treated tissues.

Common side effects of radiation therapy: Skin irritation, redness, pain and fatigue

Clinical Trials for Melanoma

Depending on your type of cancer, stage and other health factors, you may qualify to participate in a clinical trial. These carefully controlled and highly regulated research studies need volunteer patients in order to progress promising new treatment techniques.

Clinical trials at Banner MD Anderson are conducted in accordance with the National Cancer Institute. Talk to your doctor about clinical trials currently available, eligibility and other guidelines.

Melanoma Treatment Support

Cancer and its treatments cause physical symptoms, as well as affect you emotionally. Our Integrative Oncology Program offers supportive services focused on improving how you feel during treatment and caring for the non-medical needs of you and your family. This often includes therapies such as massage, acupuncture and support groups.

Choosing the best treatment options for you is one of the most important decisions in your cancer journey, and we are here to help you through this process. We customize a treatment plan for every patient to make sure you receive the right care for your specific needs. We are  here for you every step of the way.

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