Treatment for Melanoma

If you are diagnosed with melanoma skin cancer, your doctor will discuss the best options to treat it. Your treatment for melanoma at MD Anderson will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

The type of melanoma surgery your doctor uses depends on the thickness of the melanoma tumor and if it has spread.

Melanomas less than 1 millimeter thick

The most often-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 tumor thickness of the melanoma. Most patients usually do not need more treatment.

Depending on the size of the melanoma, the local excision may be an inpatient or outpatient procedure, often with local anesthesia. The area may require stitches, and recovery can take a few weeks. The severity of the scar depends on the size, depth and location of the melanoma.

Your surgeon may discuss a procedure called lymphatic mapping and sentinel lymph node biopsy (see illustration below). It is 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. This is done at the same time as the skin cancer surgery. If you have a skin graft, you may have to take special care of the area until it heals.

In addition to a wide excision, your melanoma surgical oncologist will often 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.

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.

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.

Metastatic melanoma (stage IV):

Surgery may sometimes be used to treat melanoma that has spread to distant parts of the body.

Radiation therapy

In collaboration with skilled radiation oncologists, cancer radiation therapy may be used as a component of your melanoma treatment plan. Radiation therapy may sometimes be combined with chemotherapy.

Targeted therapy

These innovative treatments, many of which were developed in part at MD Anderson, 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 trials

Immunotherapy

These innovative treatments help the body’s natural immune response fight the cancer. Immunotherapy generally is used in advanced melanoma when the cancer has spread to other parts of the body. Treatment may include:

• Interferon-alpha
• Anti-CTLA-4
• Vaccines
• Interleukin 2
• T Cell therapy
• Biochemotherapy

In some cases, chemotherapy may be combined with interleukin 2, interferon and/or T-cell therapy.

Chemotherapy

MD Anderson offers the most up-to-date and effective chemotherapy options.

Follow-up after treatment

If you have had a melanoma, you are at higher risk of developing new melanomas than someone who has never had a melanoma. You may be at risk of the cancer coming back in nearby skin or in other parts of the body. The chance of recurrence is greater if the melanoma was thick or had spread to nearby tissue. Your family members also should have regular checks for melanoma.

To increase the chance of finding a new or recurrent melanoma as early as possible, follow your doctor's schedule for regular checkups. If you are at high-risk for recurrence, follow-up care may include X-rays, blood tests and imaging scans of the chest, liver, bones and brain; if you have very early stage melanoma, these tests are generally not performed unless specific situations arise.