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Melanoma Treatment

Surgical treatments

Surgery is the primary treatment for early stage melanoma. The skin tumor is removed with the surrounding normal skin in an effort to prevent the melanoma from coming back into the skin. In addition to this, some of the lymph nodes have to be removed to determined if the melanoma has spread.

A new technique has been developed to identify and remove the specific lymph node or nodes that may contain melanoma. These are called sentinel lymph nodes, which may be detected using a blue dye along with a radioactive tracer. The sentinel node biopsy recently has been adopted for melanomas greater than one millimeter thick. This biopsy is important to determine if melanoma has spread to the sentinel lymph node. If it has spread to the sentinel lymph node, additional treatment may be recommended. Ellis Fischel Cancer Center is participating in a nationwide trial with the University of South Florida, M.D. Anderson Cancer Center, the University of Louisville and others to study the role of sentinel node biopsy in the management of melanoma. If a melanoma has spread to nearby lymph nodes, cancer specialists may recommend additional therapy to prevent its spread to other parts of the body.

If the melanoma is extensive in either an arm or leg, and has not spread to other locations, it is possible to give chemotherapy just to the arm or leg. This is called a 'hyperthermic isolated limb perfusion'. This treatment results in control of the melanoma in the limb in 80% of patients.

Radiation therapy

The main treatment for melanoma continues to be surgery. However, for localized melanomas in medically inoperable patients or for melanomas located in critical areas of function or cosmesis (face), there is good data that local radiation is as effective as surgical removal. When lymph nodes are removed which contain melanoma, radiation is often given after surgery. In the palliative setting, radiation is often effective in alleviating the symptoms of progressive melanoma in the bone, brain, bronchus, etc.

Chemotherapy

Chemotherapy is often used for melanoma that has metastasized to distant sites beyond the lymph nodes (Stage IV). Dacarbazine (DTIC) is the only FDA approved chemotherapy drug for melanoma. Other drugs used for melanoma include cisplatin, carmustine (BCNU), vinblastine, vincristine, and bleomycin. Combinations of chemotherapy drugs improve the ability to shrink the tumors (from 20 percent of the time to 30-40 percent of the time) but rarely cause complete remissions or cures. As such, better chemotherapy drugs and combinations are needed for this disease.

Immunotherapy

Interferon-alpha is a natural protein produced in the body which inhibits and kills viruses and stimulates immune cells. It also kills cancer cells directly, and inhibits the formation of new blood vessels. It is produced as a drug by recombinant DNA technology, and is used against several human cancers. It is approved by the FDA for use against melanoma after surgical removal of either involved lymph nodes (stage III) or a deep primary melanoma (stage II). It is injected by vein for one month and under the skin for 11 months, and produces side-effects that feel like a chronic flu. Overall, it increases the rate of survival after surgery by one third (from 30 percent to 40 percent). It is also used by itself or with other drugs in metastatic disease, with an overall response rate of 20 percent.

Interleukin-2 is similar to interferon-alpha in that it is a natural immune-stimulating protein, now produced by recombinant DNA technology. It does not kill tumor cells directly, requiring the patient's immune cells to function. It is FDA approved for kidney cancer, but is used often for melanoma. It is the most effective drug against advanced melanoma, but produces long-term survival in only 10 percent of patients receiving the drug. Additionally, it can cause severe temporary side effects. It may be more potent when combined with interferon-alpha and/or chemotherapy drugs. Trials using chemotherapy drugs with interleukin-2 and interferon-alpha (so-called biochemotherapy regimens) have produced encouraging results, but the toxicity is high, and it is still not proven that these more aggressive programs are better.

Vaccines have been used for melanoma for over 40 years, with limited success to date. New technology and better vaccines are on the horizon, but this strategy is as yet unproven for melanoma, either resected high-risk disease or metastatic disease.