Melanoma is the most dangerous type of skin cancer, says the National Institutes of Health (NIH), and the leading cause of death from skin disease. It is cancer arising from melanocytes, cells that produce melanin in the skin. Melanin is responsible for skin and hair color.
Treatment options for melanoma depend on several factors like the type of melanoma, site of the cancer, extent of spread, patient’s state of health and personal preferences. A combination of treatment options is used in most cases of melanoma.
Surgery
Early stage melanomas can be cured by surgical removal of the cancer along with a rim of healthy tissue, according to the American Society of Clinical Oncology (ASCO). A skin graft may be required to reduce scarring following the surgical excision. Melanoma on the finger or toe may require partial or total amputation of the involved digit.
Sentinel lymph node biopsy is the surgical removal of the lymph node nearest to the melanoma to check for signs that the cancer spread beyond the primary site. A regional lymph node dissection is performed to remove the remaining lymph nodes in the area of the cancer if any sign of cancer is found in the sentinel lymph node.
Surgery may also be performed in advanced melanoma that has spread to distant organs like the lungs and brain. In this case, the aim is to improve quality of life rather than achieve a cure. It's possible to surgically remove isolated cancer deposits in the lungs or brain to control spread or relieve symptoms.
Immunotherapy
Immunotherapy boosts the immune system to recognize and kill cancer cells. Interferon alpha-2b is used with surgery and/or chemotherapy to treat melanoma. According to the ASCO, this treatment has been consistently effective in preventing recurrence following surgical removal, when used as an adjuvant treatment. Another immune system component, interleukin-2, is also used to treat melanoma. According to the American Cancer Society (ACS), either interferon alpha-2b or interleukin-2 can be used alone in advanced disease, where surgery is no longer possible, to shrink the cancer mass in a number of cases. These two compounds, also called cytokines, can also be combined with chemotherapy for advanced or inoperable melanoma.
Other forms of immunotherapy used in melanoma treatment are Bacille Calmette-Guerin (BCG), vaccine and imiquimod cream.
Chemotherapy
Drugs that directly destroy cancer cells or stop them from growing and spreading are used in chemotherapy for melanoma. According to the ACS, chemotherapy is not as effective against melanoma as in other types of cancer, but it can be used in some advanced cases to prolong life and relieve symptoms.
Systemic chemotherapy, requiring intravenous injections and/or oral tablets, delivers chemotherapy to cells all over the body. Drugs used in systemic chemotherapy to treat melanoma are dacarbazine, carmustine, cisplatin, carboplatin, vinblastine, Temozolamide and paclitaxel. Combinations of drugs can be used, like the Dartmouth regimen with dacarbazine, carmustine, cisplatin and tamoxifen. Another combination used in melanoma is the CVD regimen of cisplatin, vinblastine and dacarbazine. These drugs may also be combined with immunotherapy as chemoimmunotherapy or biochemotherapy, which is thought to be more effective than chemotherapy alone.
Regional chemotherapy or the isolated limb perfusion is also used to treat advanced melanoma restricted to the limbs. Here, a limb is tied off and the chemotherapy agent, usually melphalan, is injected into the major arterial supply of that limb. This delivers high doses of the drug directly to the melanoma and spares the rest of the body from otherwise severe adverse effects.
Radiation Therapy
Radiation therapy, the use of high-powered radiation to destroy cancer cells, is not often used in primary melanoma arising from the skin. According to the ACS, it is mainly used in melanoma that has spread to the brain or bones, to prolong life or relieve symptoms as palliative treatment. It is also used as adjuvant treatment following surgery to prevent recurrence of melanoma, where there is involvement of the lymph nodes. The type of radiation therapy used is external beam radiation therapy.
