Treatment of Recurrent Melanoma

Recurrent melanoma is usually resistant to standard systemic treatment, and metastatic melanoma that continues to progress is not likely to be effectively treated with standard systemic therapy. These patients may be encouraged to participate in clinical trials of newer treatment strategies. These therapeutic choices may prolong survival, reduce symptoms of progressive cancer, and/or offer the chance of a cure.

• Chemotherapy - Although recurrent melanoma is usually not effectively treated with standard chemotherapy, studies with DTIC, BCNU, and other agents have shown some promise. So far, the responses to treatment in these studies have lasted only a few months. Slightly higher response rates have been achieved with three-drug combinations.
• Biologic agents - Alpha-interferon and interleukin-2 have shown the most benefit in recurrent melanoma.
• Combination chemotherapy and biologic therapy - Some studies have shown that combining chemotherapy with biologic agents boosts the response rate of the disease to these agents.
• Surgery - Surgical removal of isolated metastases may prolong survival in some patients with recurrent melanoma. This can be an important treatment option for patients with recurrent metastatic melanoma for whom other treatments are ineffective. It may also be helpful to those who have a partial response to biologic therapies (immunotherapies) or chemotherapy.
• Radiation therapy - Radiation therapy can relieve symptoms, especially pain from cancer that has spread to the bone. Radiation therapy should be considered in patients who have had surgical removal of a single brain melanoma.
• Isolated limb perfusion - For several decades, patients have been treated with isolated limb perfusion in attempts to prevent amputation or mutilating surgery in recurrences that are localized to a single arm or leg. This technique delivers chemotherapy only to the affected limb. It is believed to be more effective for the following reasons:
  
  • The chemotherapy agent does not become diluted before reaching the cancer by mixing with the rest of the blood from the body.
  • The chemotherapy agent is not broken down in the body through biochemical processes before reaching the cancer.
  • Greater amounts of the chemotherapy agent can reach the cancer with fewer side effects.