Five Types of Melanoma Treatment

There are different types of treatment available for patients with melanoma.  Standard treatments are those currently used by dermatologists today. There are also treatments that are being tested in clinical trials. A clinical trial is a treatment done by a research study meant to help current treatments or obtain information on new treatments.

If a clinical trial shows that a new treatment is better than the standard method, that new treatment may become the new standard. Patients may want to consider taking part in a clinical trial, though some clinical trials are only open to patients who have not started treatment already. Before you make this decision, consult with your dermatologist.

Surgery

Removing the tumor via surgery is the primary treatment for all stages of melanoma. Your doctor can remove the tumor using any of these procedures:

  • Wide local excision:  This is where the doctor removes the melanoma and some of the surrounding normal tissue. Also, he or she may remove some of the lymph nodes.
  • Lymphadectomy:  In this procedure, the dermatologist removes some of the lymph nodes. A sample of tissue is checked under a microscope for any signs of cancer cells.
  • Sentinel lymph node biopsy:  The sentinel lymph node is the first lymph node where the cancer is likely to spread to from the tumor. The dermatologist always removes this node. First, a blue dye and/or a radioactive substance is injected near the tumor. The dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. This node is examined under a microscope by a pathologist for cancer cells. If no cancer cells are found, the doctor may find it unnecessary to remove anymore nodes.
  • Skin grafting:  This is where the dermatologist takes skin from another part of the body to replace skin that has been removed. It may be done to cover the wound from the surgery.

Chemotherapy

Cancer treatment that uses drugs to stop the growth of cancerous cells is called chemotherapy. These drugs can be given by mouth or by injection into a vein or muscle. The drug enters the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy. Chemotherapy can be placed directly into the cerebrospinal fluid, an organ, or a body cavity like the abdomen. This is called regional chemotherapy, as the drugs mainly affect cancer cells within those regions.

Hyperthermic isolated limb perfusion is one type of regional chemotherapy. An anticancer drug mixed with a warm solution is inserted directly into the arm or leg where the cancerous cells were found. The flow of blood is temporarily stopped with a tourniquet. This gives a high dose of drugs to the area where the cancer is located.

The administration of chemotherapy depends on the type and stage of the cancer being treated. Even if the doctor removes all the melanoma seen at the time of the operation, patients may receive chemotherapy after surgery to kill any cancerous cells that may have been missed. Chemotherapy given after surgery lowers the risk that cancer will return, and doctors call this adjuvant therapy.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells, or keep them from growing. There are two types of radiation therapy:  external and internal. The two types of radiation therapy differ in the way they are given, but work in the same way in order to kill the cancerous cells.

External radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters. The doctor places these sealed devices directly into or near the cancer. Your doctor will choose which type is best for you depending on your type and stage of cancer.

Biologic Therapy

Biologic therapy uses the patient’s own immune system to fight the cancer. Laboratory-made substances (or substances biologically made) are used to boost, direct or restore the body’s natural defense against cancer. This treatment is also known as biotherapy or immunotherapy.

Two common biologic agents are Interferon and interleukin-2. Interferon, one of the two types of biologic therapies used to treat melanoma, affects the division of cancer cells and can slow the growth of a tumor. Interleukin-2 (IL-2) boosts the growth and activity of several immune cells, specifically lymphocytes, type of white blood cells which attacks and kills cancer cells.

Tumor necrosis factor (TNF) is an agent that is also a biologic therapy for melanoma. It is used in addition to other treatments for melanoma. TNF is a protein made by white blood cells that respond to an antigen or infection. Tumor necrosis factor can be reproduced in a laboratory and used to kill cancer cells.

Targeted Therapy

Targeted therapy uses drugs or other substances to identify and attack cancerous cells. Certain types of targeted therapy are currently being used to treat melanoma. These include:

  • Monoclonal Antibody Therapy:  This form of treatment uses antibodies made in a laboratory from a single type of immune system cell. These antibodies identify substances on both cancerous and normal cells that may help the cancer cells grow. The antibodies attach themselves to these substances and kill the cancer cells, block their growth, or keep them from spreading. These antibodies are given by infusion, and they can be used to carry drugs, toxins or radioactive material directly to the cancer cells. Ipilimumab, a monoclonal antibody, can be used with chemotherapy as adjuvant therapy to treat melanoma.
  • Signal Transduction Inhibitor Therapy: The method of treatment blocks signals that are passed from one molecule to another inside a cell. By blocking these signals, these inhibitors may kill cancer cells. Vamurafenib is one of these inhibitors, and it is used to treat some patients with advanced melanoma or tumors that cannot be removed through surgery.
  • Oncolytic Virus Therapy:  This is a type of targeted therapy currently being studied. It uses a virus that infects and breaks down cancer cells but not normal cells. Radiation or chemotherapy may be given after oncolytic virus therapy to kill more cancerous cells.
  • Angiogenesis Inhibitors:  These are currently being studied in clinical trials, and these agents are types of targeted therapy. Angiogenesis inhibitors block the growth of new blood vessels, which tumors need in order to grow.

Re-Staging and Follow-Up Tests

Some of the same tests that were done to diagnose the cancer, or to stage the cancer, may need to be repeated. The dermatologist does these tests to see how well the treatment is working. These follow-up tests allow the doctor to decide whether continued treatment is needed, a change in treatment needs to be made, or if treatment can be stopped. This is called re-staging. Re-staging and follow-up tests are necessary from time to time to check for recurrence of the melanoma.