Treatment Options

Treatment Option Overview

Different types of treatment are available for patients with melanoma. Some treatments are standard while others are being tested in clinical trials.

Five types of standard treatments are used:

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Biologic therapy
  • Targeted therapy

Surgery

Surgery to remove the tumor is the primary treatment for all stages of melanoma. A wide local excision removes the melanoma and some of the surrounding normal tissue. Skin grafting may be used to cover the wound caused by surgery. It is important to know whether the cancer has spread to the lymph nodes; previously mentioned techniques, like lymph node mapping and sentinel lymph node biopsy are performed to check for cancer in the lymph nodes during surgery.

Even if the clinician removes all the melanoma that can be seen at the time of surgery, some patients may be given chemotherapy after surgery to kill any remaining cancer cells. Chemotherapy given after surgery, called adjuvant therapy, lowers the risk of the cancer coming back. Surgery to remove cancer that has spread to the lymph nodes, lung, gastrointestinal (GI) tract, bones, or brain may be performed to improve the patient’s quality of life by controlling symptoms.

Chemotherapy

Chemotherapy is a cancer treatment which uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy is taken orally or injected into a vein or muscle. The drugs enter the bloodstream and then reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs attack the cancer cells in those specific areas (regional chemotherapy).

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters placed directly into or near the cancer. The way in which radiation therapy is administered depends on the type and stage of the cancer. External radiation therapy is used to treat melanoma.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy. Various types of biologic therapy are being used or studied in the treatment of melanoma.

  • Interferon: Interferon affects the division of cancer cells and can slow tumor growth.
  • Interleukin-2 (IL-2): IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
  • Tumor necrosis factor (TNF) therapy: TNF is a protein made by white blood cells in response to an antigen or infection. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma.
  • Ipilimumab: Ipilimumab is a monoclonal antibody that boosts the body’s immune response against melanoma cells. Other monoclonal antibodies are being studied in the treatment of melanoma.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy. New targeted therapies are being studied in the treatment of melanoma.

  • Signal transduction inhibitor therapy: Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells.
  • Vemurafenib, dabrafenib, and trametinib are signal transduction inhibitors used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. Vemurafenib and dabrafenib block the activity of proteins made by mutant BRAF genes. Trametinib affects the growth and survival of cancer cells.
  • Oncolytic virus therapy: A type of targeted therapy that is being studied in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.
  • Monoclonal antibody therapy: Monoclonal antibodies are made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
  • Pembrolizumab is a monoclonal antibody used to treat patients whose tumor cannot be removed by surgery or has spread to other parts of the body.
    Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.

Treatment options by stage

Stage 0 (Melanoma in situ)

Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.

Stage I Melanoma

Treatment of stage I melanoma may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and removal of lymph nodes is also done.
  • A clinical trial of new ways to find cancer cells in the lymph nodes.

Stage II Melanoma

Treatment of stage II melanoma may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
  • Surgery followed by biologic therapy with interferon if there is a high risk that the cancer will come back.
  • A clinical trial of new types of treatment to be used after surgery.

Stage III Melanoma that can be removed by surgery

Treatment of stage III melanoma that can be removed by surgery may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Skin grafting may be done to cover the wound caused by surgery. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
  • Surgery followed by biologic therapy with interferon if there is a high risk that the cancer will come back.
  • A clinical trial of new kinds of treatments to be used after surgery.
  • A clinical trial of injections into the tumor, such as oncolytic virus therapy.

Stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma

Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include the following:

  • Targeted therapy with vemurafenib or dabrafenib
  • Biologic therapy with interleukin-2 (IL-2), ipilimumab, or pembrolizumab
  • Chemotherapy
  • Palliative therapy to relieve symptoms and improve the quality of life. This may include:
    • Surgery to remove lymph nodes or tumors in the lung, gastrointestinal (GI) tract, bone, or brain
    • Radiation therapy to the brain, spinal cord, or bone

Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following:

  • Biologic therapy agents alone or in combination.
  • Targeted therapy with other signal transduction inhibitors.
  • Angiogenesis inhibitors
  • Targeted therapy for melanoma with gene mutations
  • Treatment with injections into the tumor, such as oncolytic virus therapy
  • Surgery to remove all known cancer
  • Regional chemotherapy (hypothermic isolated limb perfusion). Some patients may also have biologic therapy with tumor necrosis factor
  • Systemic chemotherapy

Clinical trials

Clinical trials are part of the cancer research process. Cancer trials are done to find out if new cancer treatments are safe and effective or better compared to the standard treatment. Clinical trial participation is often offered to people with high-risk stage II, stage III, or stage IV melanoma. People with persistent or recurrent melanoma may also be offered clinical trial participation.

Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not improved. There are also some that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

 

[7] “Melanoma Treatment.” National Cancer Institute. National Cancer Institute, 2015. Web. 03 July 2015.
[1] Winslow, Terese. Stage 0 (Melanoma in Situ). Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[2] Winslow, Terese. Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm. Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[3] Winslow, Terese. Stage I. Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[4] Winslow, Terese. Stage II. Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[5] Winslow, Terese. Stage III. Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[6] Winslow, Terese. Stage IV. Digital image. Melanoma Treatment (PDQ®). National Cancer Institute, 2008. Web. 17 June 2015.
[7] “Melanoma Treatment (PDQ®).” National Cancer Institute. National Cancer Institute, 15 May 2015. Web. 17 June 2015.