Melanoma treatment decisions are based on the location and stage of the tumor, and factors specific to the individual patient. At Virginia Mason, a dedicated treatment team may include dermatologists, nurses, oncologists, pathologists, radiologists, social workers and surgeons. An oncology nurse coordinator assists each patient throughout his or her treatment course, from referral to recovery. A treatment plan may include:
- Surgery — including wide margin removal and reconstruction of the tumor site, sentinel lymph node biopsy, removal of lymph nodes or metastases
- Radiation therapy
- Vaccine therapy
- Clinical trials
Treatment for the Primary Tumor
Treatment options for patients with melanoma will depend upon the stage of disease and whether or not the cancer has spread to the lymph nodes and other organs. Surgery is the mainstay of treatment to remove the tumor.
When cancer is caught at an early stage - when the tumor is less than 1 millimeter in thickness - your surgeon will perform a wide local excision that removes both the tumor and a margin of tissue around it. If the tumor is thicker than 1 millimeter, your surgeon will also want to test the lymph nodes near the tumor site for signs of cancer. Usually, a sentinel lymph node biopsy is performed that removes the node or nodes where cancer is most likely to spread first.
If cancer is present in these lymph nodes, your surgeon will want to remove additional lymph nodes, usually during another scheduled surgery.
Invasive melanoma, in which the cancer has grown deep into the skin, will require more extensive surgery and may also require reconstructive surgery to close the site. Virginia Mason plastic surgeons perform a high volume of surgeries for patients with melanoma, and with excellent outcomes.
Patients who have had a primary melanoma have a risk of a second primary melanoma that is significantly greater than the risk for a first primary melanoma in the general population, as well as a risk of recurrence. Second primary melanomas develop at a rate of approximately 0.5 percent per year for the first five years and at a lower rate thereafter. The incidence of a second primary tumor is especially high in patients aged 15 to 39, or 65 to 79.
For these reasons, patients are generally followed closely by their dermatologist and oncologist, as well as by their primary care physician after the initial treatment for cancer. Current follow-up recommendations include at least annual, lifelong comprehensive skin exams for all melanoma patients, including those with stage 0 (melanoma in situ) disease. Patients with invasive disease usually have more frequent exams and additional imaging tests (X-rays, CT scans).
The most common site of recurrence of the original cancer is in the regional lymph nodes close to the tumor site (46 percent), followed by local or in-transit metastases (30 percent) and distant metastases (24 percent). Treatment for recurrent melanoma may involve surgery and also chemotherapy, either alone or in combination with another therapy. Unfortunately, melanoma that recurs is often difficult to treat.
Treatment for Metastatic Melanoma
When melanoma metastasizes, it may spread not only into lymph nodes but also to internal organs, including the liver, lungs, colon, brain or bones. Surgery may be an option in some cases but, unfortunately, it is not a cure. A number of other therapies are available to help control the spread of cancer and relieve the symptoms of treatment.
Chemotherapy is the use of powerful anticancer drugs usually given intravenously as an IV solution. It works by stopping the division of cell growth in the body. Chemotherapy patients are at risk of losing their hair and of developing anemia (low blood cell production), which may bring on chronic fatigue. A course of chemotherapy may consist of several cycles several weeks apart.
Isolated limb infusion (ILI)
With ILI treatment, chemotherapy is infused directly into the arm or leg where melanoma has occurred. The benefits of this treatment are that only the affected area is treated and a higher dose of the chemotherapy agent can be given. ILI therapy is usually only indicated in patients with recurrent melanoma on a limb. Currently, this treatment is available at select medical centers, including Virginia Mason.
Chemoimmunotherapy - also called biochemotherapy - combines chemotherapy with biologic therapy that boosts the immune system to help fight cancer.
Biologic therapy - also called immunotherapy - uses a substance made in a lab or within the body itself that helps stimulate or restore the immune system to fight cancer. A healthy immune system recognizes foreign invaders, including cancer cells, and mounts an attack to kill these cells. When the immune system is compromised, as can happen with cancer or cancer treatment, it may need a boost to fight disease. Interferon-alpha-2b and interleukin-2 (IL-2), are types of biologic therapies given by injection to help boost the immune system. Some biologic therapies and combinations of these therapies may be available only within clinical trials.
Vaccine therapy is a type of biologic therapy that helps stimulate the body's immune system to recognize specific cancer cells. The vaccine is given after the disease has been diagnosed.
Radiation therapy may help alleviate pain associated with cancer that has spread to the bones or brain by shrinking the tumors. It may also be used in combination with another therapy or with a "boost" (an injected drug) that increases the effectiveness of the radiation treatment. A course of radiation therapy may be given over several days using external beam radiation. There are several types of external beam radiation therapy, most of which use computer analysis to identify, measure and target the tumor, thus sparing healthy surrounding tissue.
Virginia Mason provides patients with opportunities to participate in many different cancer clinical trials. Patients also benefit from our partnership with Benaroya Research Institute at Virginia Mason, a world-class research institution that is looking at the causes and cures of leading diseases, and is making those discoveries available to patients through translational ("bench to bedside") medicine.