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, surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, social workers and nurses. 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
- 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. Depending on the specific features of your melanoma, your surgeon may 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 may want to remove additional lymph nodes, usually during another scheduled surgery.
Sometimes extensive surgery for melanoma may 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, specialized medical therapy, and sometimes radiation therapy.
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. A number of other therapies are available to help control the spread of cancer and relieve the symptoms of treatment.
Immunotherapy describes specialized medical therapy that boosts the immune system to help the body recognize and fight melanoma.
Targeted therapy describes the use of drugs that target the parts of melanoma cells that make them different from normal cells in the body. Genetic testing of melanoma cells that are removed can help to identify which specific targeted therapies might work best for a person’s melanoma.
Radiation therapy may help by shrinking tumors or treating areas that are at high risk for recurrence after initial 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.