Treatment of Stage III Melanoma

Stage III melanoma may be a tumor that is between 1 and 4 millimeters thick, with no sign that the cancer has spread to lymph nodes or distant organs. Or it may be a tumor of any thickness, with spread to one or more lymph nodes but not to distant organs.

Surgical Treatment for Stage III Melanoma

Surgical treatment is standard for stage III melanoma. The primary tumor is removed with up to 2-centimeter (about 1-inch) margins. The size of the area to remove depends on the thickness of the primary tumor.

In addition to local excision, all regional lymph nodes are removed in stage III melanoma. Lymph nodes may be removed from the neck, armpit, or groin, depending on the location of the tumor and which lymph glands are suspect.

Side effects of removing lymph nodes vary depending on the extent of disease, the patient’s weight, and whether he or she has had postoperative radiation at the site of the melanoma. Side effects of lymph node removal may include numbness and swelling of the associated arm or leg (lymphedema).

Adjuvant Treatment for Stage III Melanoma

Patients with stage III melanoma are at high risk for disease recurrence due to the presence of undetectable cancer cells (micrometastases). For this reason, surgery may be followed by adjuvant treatment. Adjuvant treatment is cancer treatment that is provided after local treatment with surgery to reduce the risk of recurrence. Adjuvant treatment may include radiation therapy, chemotherapy with or without biologic therapy, and/or vaccines.

Multimodality treatment, which uses two or more treatment techniques, is increasingly recognized as an important tool for improving a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial using new, innovative therapies may provide the most promising treatment.

Radiation Therapy for Stage III Melanoma

Radiation treatment is useful in controlling or eliminating any residual microscopic disease left behind after surgery in some patients with stage III melanoma. Radiation may help if:

• Cancer cells are detected by microscope in the surgical margins (positive margins)
• The melanoma has recurred
• There are thick primary tumors with ulceration
• There is evidence of satellite cancer cells (cancer cells in the lymph vessels surrounding the tumor)
  

The risk that melanoma will recur after lymph nodes have been removed depends on a number of factors. The highest risk occurs when:

• Four or more lymph nodes are positive
• The removed lymph nodes measure at least 3 centimeters
• Positive lymph nodes have been found in the neck (cervical region)
• There is evidence that the tumor has spread beyond the capsule of the normal lymph node (extracapsular extension)
  

When any of these factors are present, a short course of radiotherapy delivered to the region of the melanoma may help to reduce the risk of recurrence.

Biologic Therapy for Stage III Melanoma

High-dose alpha interferon is a biologic therapy that stimulates the immune system. Alpha-interferon has been approved by the U.S. Food and Drug Administration for adjuvant treatment of stage III melanoma. No improvement in recurrence rates or survival has been reported with use of lower doses of alpha-interferon. Patients with stage III disease appear to have some benefit from high-dose adjuvant interferon therapy. A number of ongoing clinical trials are evaluating alpha-interferon, vaccines, and other anticancer therapies alone or in combination. If you have stage III melanoma, you should consider all of these options, including participation in a clinical trial, before beginning treatment. For patients who do not wish to participate in a clinical trial, the standard treatment is high-dose alpha-interferon.

Vaccine Therapy for Stage III Melanoma

Vaccines are thought to have great potential in the treatment of melanoma, but none studied have yet been proven to be effective. The idea behind a melanoma vaccine is that certain proteins that are unique to melanoma tumors may be given as an injection, activating the immune system to form antibodies to attack and kill the cancer cells. It is hoped that vaccines will work by activating the immune system specifically against melanoma without causing significant toxic effects. Clinical trials with melanoma vaccines are ongoing.

Prognosis for Stage III Melanoma

The extent or amount of cancer in the lymph nodes is the most important prognostic factor for patients with stage III melanoma. The presence of micrometastases (cancer cells detected by sentinel node biopsy) is more favorable than the presence of macrometastases (clinically detectable metastases in the lymph nodes). Similarly, having one lymph node that contains cancer cells is more favorable than having cancer cells in four or more lymph nodes.