How Is Melanoma Treated?

The choice of treatment for melanoma depends on the stage of the disease. In general, treatment consists of complete surgical removal of the melanoma, evaluation of the lymph nodes in the area for evidence of cancer cells, and prevention of further spread or recurrence of the disease.

When a melanoma is thicker than 1 millimeter, the regional lymph nodes may be biopsied. A biopsy may also be done with thinner melanomas. If the sentinel node is positive for cancer cells, all the lymph nodes near the melanoma are removed. If the sentinel node is negative, no additional surgery is needed.

When melanoma is detected early, up to 95 percent of patients will survive 5 years or longer (this is considered a cure), with a low likelihood of recurrence. Patients with more advanced disease should remain hopeful because cure rates continue to rise with newer treatments.

Once melanoma has spread to distant organs, surgery cannot cure the disease. However, surgical removal of the tumors can bring symptom relief. For more advanced cases of melanoma, chemotherapy, immunotherapy, and radiation therapy may be used.

Research is in progress to refine existing treatments and develop new ones.

Strategies To Improve Treatment For Melanoma

Researchers are currently investigating new treatments for melanoma. Participation in trials of these treatments can help lead to improved therapies.

• New treatment regimens - Phase II clinical trials are studying multidrug chemotherapy treatment regimens that incorporate new or additional anticancer therapies. Combining chemotherapy with biologic agents seems to be very promising. Most of the clinical trials are now being conducted on DTIC dacarbazine, the platinum compounds Platinol^® (cisplatin) and Paraplatin^® (carboplatin), BCNU (carmustine), and both Proleukin^® (aldesleukin) and alpha interferon. Newer drug combinations and other biologic agents will continue to be evaluated.
• Allogeneic stem cell transplant - In this procedure, the patient receives high doses of chemotherapy or radiation, which kill the cancer cells but may damage the patient’s immune system. Stem cells are then transplanted from a healthy person (the graft) into a patient (allogeneic stem cell transplant). These stem cells can restore the patient’s immune system. This therapy can cure patients with other types of cancer. Early trials are evaluating the role of allogeneic stem cell transplantation in the treatment of melanoma.
• Vaccines - No vaccine has been approved by the FDA for the treatment of metastatic disease or for the prevention of a relapse. Melanoma vaccines produce responses, often dramatic, in some patients. Results, however, are far from consistent. Further studies of vaccines are now ongoing.
• New biologic therapies - One type of biologic therapy that has produced favorable preliminary results is granulocyte macrophage colony-stimulating factor (GM-CSF), a type of cytokine (a substance in the body that helps to enhance the immune system). GM-CSF is a promising option for cancer therapy because of its potential to be effective against disease without the serious side effects of many chemotherapy drugs. Cytokines, such as GM-CSF, are most effective when there is only a minimal amount of cancer remaining after surgery.
• Maintenance biotherapy - Maintenance therapy consisting of aldesleukin and GM-CSF appears to significantly improve survival time for patients with advanced melanoma who respond to initial biochemotherapy.
• Gene therapy - Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a faulty gene or replacing or adding a functional gene into a cell to make it operate normally. Many gene therapy studies are being carried out in patients with refractory melanoma. If successful, these therapies could be applied to patients with an earlier stage cancer. Currently, no gene therapies are approved for the treatment of melanoma.
• Antisense treatment - Some advanced-stage cancers, including some melanomas, can become resistant to chemotherapy drugs, making the drugs less effective or ineffective against the cancer. One factor in the development of disease resistance in some cancers (melanoma included) is thought to be an abnormal gene called the bcl-2 gene.
• Researchers have been working to develop drug products that may help overcome such resistance by targeting the bcl-2 gene, which provides more effective treatment options. A new drug application has been accepted for fast-track status by the FDA for Genasense® (oblimersen sodium). This is the first systemic antisense therapy to get this far in the approval process for new drugs. The drug is to be used in combination with dacarbazine chemotherapy for the treatment of patients with advanced melanoma who have not yet received any chemotherapy.

Supportive Care For Advanced Melanoma

Supportive care consists of treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. To achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed.

Follow-Up After Melanoma Treatment

Patients who have been diagnosed with melanoma are 10 to 25 times more likely than the general population to develop a second melanoma. As a result of this increased risk, patients should be evaluated using monitoring strategies that are appropriate to the original stage of their melanoma. These evaluations should include a history with investigation of specific symptoms and a physical exam that includes a detailed skin and lymph node assessment. Routine skin examinations are designed to detect and treat a second melanoma in its earliest stages.

Patients who have routine skin examination and education on self-examination after the diagnosis of their primary melanoma are likely to detect second melanomas at an earlier stage (see “Screening and Prevention”).