Skin Cancer Treatment Options

The treatment of melanoma depends on the stage at which it is diagnosed. For most melanomas, Surgery remains the most effective treatment for melanoma. At any stage of disease, people with melanoma may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, and to ease emotional and practical problems.

In addition to using the latest treatment options, you can participate in ongoing, clinical trials, examining new approaches to treating skin cancer.

Treatment Options By Stage

Stage 0 Melanoma is usually treated with a wide local excision to remove the tumor and a small amount of normal tissue around it.

Stage I Melanoma is usually treated by wide local excision to remove the tumor and a small amount of normal tissue around it.

Stage II Melanoma treatment options include:

• Wide local excision to remove the melanoma and some of the normal tissue around it, followed by removal of nearby lymph nodes.
• Lymphatic mapping and sentinel lymph node biopsy, followed by wide local excision to remove the tumor and some of the normal tissue around it. If cancer is found in the sentinel lymph node(s), this then becomes classified as Stage III melanoma (see below).
• For thick melanomas (4 mm Breslow thickness), even with normal lymph nodes, additional adjuvant therapy with high dose interferon alfa-2b is sometimes recommended (see below under Stage III).

Stage III Melanoma (Melanoma that spreads to the lymph nodes) treatment options include:

• Wide local excision to remove the melanoma and some of the normal tissue around it.
• Regional lymph node dissection. Most often, these days, Stage III is diagnosed by finding microscopic spread of the melanoma to the regional lymph nodes (most commonly in the neck, under the arm-called the axilla, or in the groin area) by sentinel lymph node biopsy. Sometimes, however, patients are found to have enlarged lymph nodes full of cancer. In any event, the procedure of choice when there is any sign of cancer in the lymph nodes is to remove all of the lymph nodes in that area, called lymphadenectomy or lymph node dissection. For Stage III melanoma, some patients are cured just by removing these lymph nodes.
• We believe that the best chance of cure for patients with cancer in the lymph nodes is to detect the lymph node metastases early, rather than wait until the lymph nodes become enlarged and full of cancer. Sentinel lymph node biopsy is the best way to find early spread of the melanoma to lymph nodes.
• Once cancer is diagnosed in the lymph nodes, the risk of cancer spreading elsewhere is higher. Therefore, additional therapy is often recommended. The only Food and Drug Administration (FDA) approved therapy is high dose interferon alfa-2b (see melanoma.com).
• Clinical Trials, including melanoma vaccines.
• For patients with a particular pattern of spread of the melanoma called "in-transit disease" (tumor nodules in the skin or under the skin around the original melanoma, spreading toward the lymph nodes), hyperthermic isolated limb perfusion can be used. This is performed as an operation in which a tourniquet is applied to the affected arm or leg, and heated chemotherapy is circulated through the main artery and vein. This can be an effective treatment for advanced disease.

Stage IV Melanoma patients have melanoma that has spread beyond the regional lymph nodes and to distant sites. Most patients are not cured. Treatment options include:

• Surgery: A small fraction of patients with resectable metastases will survive long term, regardless of other types of therapy. In general, patients with Stage IV melanoma that can be surgically removed can often benefit from removing these tumors. Sometimes, surgery is performed as palliative therapy to relieve symptoms and improve quality of life.
• High dose Interleukin-2: This treatment is an immunotherapy that is given in the hospital, and can have significant side effects or toxicity. It is the only FDA-approved immunotherapy for metastatic melanoma. It can result in complete remission for a small fraction of patients (about 7%). Patients with complete remission have all the cancer disappear-sometimes for many years. Some such patients may actually be cured, although longer follow-up is needed to determine how often this happens.
• Biochemotherapy: This is an aggressive combination of chemotherapy drugs, interleukin-2 and interferon. It requires treatment in the hospital. Like high-dose IL-2, it can result in complete remission. The toxicity is significant, and the overall benefit is controversial. This is often given as part of a clinical trial.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• Chemotherapy alone, such as dacarbazine alone or the three-drug combination of cisplatin, dacarbazine (DTIC) and the carmustine (BCNU), also called the Dartmouth regimen. While chemotherapy alone can help some patients, it is not very effective overall.

Information on specific treatments under study is available under clinical trials, but this section may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI at Cancer.gov.

If the cancer has spread

If your melanoma has spread beyond your skin to other organs, such as your bones, lungs or liver, it may not be possible to eliminate the cancer at this stage. However, its spread may be controlled with radiation, chemotherapy or both. A variety of clinical trial opportunities are investigating promising new treatments for melanoma. Sometimes, patients experience a complete response to treatment, which means that the cancer shrinks away and goes into remission.