What Is The Treatment
The best treatment
available is surgery. Usually the primary tumor is removed and the diagnosis
established by examination of tumor slides under a microscope. Often a
second operation called "wide re-excision" is performed to remove
a larger area around the primary to be sure all tumor cells in that area
have been removed. This second surgery may require a skin graft. In addition,
it may be recommended that the lymph nodes be evaluated if the examination
of the primary tumor indicates a substantial chance that the tumor has
spread to the lymph nodes. This is done by a procedure called a "sentinel
node biopsy". A small amount of radioactive material or blue dye
or both are injected around the site of the primary. This is picked up
in the lymphatics and carried to the "sentinel node" the first
node draining the primary tumor. This node is removed and examined under
the microscope. I f no tumor is present, there is no need for removal
of additional nodes at the site. If the tumor is present in the sentinel
node, it will be recommended that additional nodes be removed at the site,
because they may also be involved with melanoma. The lymph nodes removed
would be either in the neck, armpit or groin, depending on the location
of the primary tumor. The sentinel node biopsy must be done before the
wide re-excision and the two procedures are usually done sequentially
during one surgical session.
What Can You Tell
Me About My Melanoma?
Slides of the primary
tumor reveal information about your particular melanoma. The thickness
of the tumor and how deeply it has penetrated the skin are related to
chances for a recurrence. A very thin tumor that does not penetrate deeply
is considered "low risk". The chances are excellent that this
tumor will be cured by the surgery. For patients with a thin melanoma,
other than regular checkups, no further treatment is usually required.
In other patients, examination of the slides may show that the tumor has
a substantial risk of recurrence. For these patients after surgical treatment,
consideration may be given to additional therapy aimed at attempting to
prevent a recurrence. Such therapy is called "adjuvant therapy"
because it is given in addition to surgery in an effort to prevent a recurrence.
What Should I
We generally recommend
that patients with melanoma have regular check-ups every three months
for two years, every six months for another two years, and annually after
that. During these check-ups the doctor will carefully check the site
of the primary and lymph nodes for signs of recurrence. A general check-up
will also be done at the time of each check-up to look for spread of the
disease not detected by the physical examination. As the patient, you
should watch for:
- • Any new unusual
pigmented lumps appearing around the site of the surgery or elsewhere
- • Any lump appearing
underneath the skin. These usually do not appear pigmented and are usually
painless. Lumps are most likely to be found in the lymph nodes, around
the site of the surgery, or between the surgical site and the lymph
- • Changes in existing
moles that might represent the appearance of a second primary melanoma.
These changes in moles might be:
- > Unusual increase
- > Change in color
- > Itching or burning
- > Change in the
border so that it may appear that the pigment is "spilling out"
- > Increase in
- > Oozing or bleeding
What If I Have
It depends on what
it is and where it is. Surgery in general is the treatment of choice,
but cannot always be done. The number of tumors, size and location are
important in determining whether surgery is possible. For tumors that
cannot be surgically excised, radiation, chemotherapy, immunotherapy, and/or experimental
treatments are all possibilities.
What Is Immunotherapy?
Standard cancer treatments
include surgery, radiation, chemotherapy or immunotherapy. Immunotherapy is newest modality
of cancer treatment and may involve the use of agents called "biological
therapy" which may enhance your own immune response to the tumor.
It may also involve use of products with immunological activities to directly
attack the tumor. Many of these recent technological breakthroughs are
the result of genetic engineering and advanced technology.
Immunotherapy is not a substitute for standard therapy, such as surgery,
but it may be used to:
- • Provide potential
therapeutic benefit to patients in an attempt to prevent recurrence
after surgery early in the course of the disease.
- • Attempt to control
tumor growth if tumors recur.
Are Considered Immunotherapy?
Interferon alpha has both a direct anti-tumor effect in melanoma and an effect in
stimulating the immune response.
Interferon has also been approved by the FDA for adjuvant therapy of melanoma
but the treatment requires the administration of high doses of drug and
is associated with severe side effects. The most recent study of interferon
as adjuvant therapy for melanoma indicated that it did not prolong survival.
Interleukin-2 is normally produced in limited quantities by the immune system. It is approved by the FDA for treating patients with metastatic melanoma that cannot be surgically excised. When used for this purpose, it must be given in high doses in the hospital and this is associated with considerable toxicity. The response rate is best in patients whose disease is limited to spread in the skin and/.or lymph nodes (Stage IV M1a).
Identify Melanoma >>