Different stages of melanoma
Different procedures will be recommended based on if the melanoma is only on the surface of the skin or has invaded deeper into the lymph nodes, organs or other areas of the body.
Below, we provide a basic overview of the common treatments offered at each stage of melanoma.
Melanoma stage 1
At stage 1, the melanoma is only present in the top layer of skin (the epidermis). To remove the melanoma, wide excision surgery is usually performed. This is when the melanoma is cut out along with a small margin of skin around it, to ensure that all of the cancer cells are removed.
In some cases, a skin graft may be needed in order to avoid significant scarring. After removing the cancerous area, doctors will examine the skin in a lab, and if cancer cells are found around the edges, they may go back to the same area to do a repeat excision.
A doctor will numb the area of the skin around the melanoma with local anesthesia during the excision. In most cases, no further treatment for melanoma will be needed.
Melanoma stage 2
At melanoma stage 2, any melanomas found in the skin will be removed through wide excision surgery.
Many doctors will also recommend a sentinel lymph node biopsy as there is a good chance cancer cells may have spread to the lymph nodes. A sentinel node biopsy is the removal of a small piece of a “sentinel” lymph node.
According to the Mayo Clinic, the sentinel nodes are the first few lymph nodes into which a tumor drains. This melanoma treatment is usually performed as an additional procedure when melanoma is being removed.
It is mainly used as a way of determining if the melanoma has spread beyond the original tumor site and into the lymph nodes.
Sometimes systemic therapies will also be recommended to kill any cancer cells that have spread throughout the body.
Melanoma stage 3
In stage 3, the cancer is present in the lymph nodes so surgery of the lymph nodes will usually be required along with excision of the original melanoma site as in the previous stages. Lymph node surgery is called lymph node dissection and all of the lymph nodes in the area where the cancer has spread will be removed.
This will be done under general anesthetic. Radiotherapy may also be used after surgery to reduce the chances of the cancer returning. This will depend on how far the cancer has spread as well as other health concerns that a doctor will weigh. Further adjuvant therapy with interferon may also be used to prevent the cancer from coming back.
This is an intravenous drug treatment. Other drug treatments may be used in combination with surgery as well.
Melanoma stage 4
Treating this stage of melanoma is difficult and oftentimes the cancer is no longer curable. The goal with most advanced stage melanoma treatments is to prevent cancer from spreading and to improve the quality of life of the patient.
Cancerous lymph nodes and metastases that have spread to internal organs will often be removed and/or treated with radiotherapy to alleviate symptoms.
Metastases that are unable to be removed may be treated with systemic therapies, therapies that travel through the bloodstream in order to treat the symptoms and prevent cancer cells from spreading. Systemic treatments include chemotherapy, targeted therapies, and immunotherapy.
Immunotherapy drugs include Imlygic, Keytruda, Opdivo, Proleukin / IL-2, and Yervoy. These drugs work with the immune system to fight diseases. A doctor can walk you through the pros and cons of each specific melanoma treatment. Immunotherapy drugs have been shown to extend the life of melanoma patients but these drugs can also have some severe side effects.
Targeted therapy drugs are usually used in cancer cells show changes in the BRAF gene. Targeted therapies direct treatment towards specific molecules that contribute to the growth, progression, and spread of cancer.
This includes Cotellic in combination with Zelboraf, Mekinist in combination with Tafinlar, Mekinist, Tafinlar, and Zelboraf used alone.
The targeted therapies are used before or after immunotherapy treatments, but they are never both used at the same time. These melanoma treatments can also have severe side effects.
Chemotherapy can sometimes help people with advanced melanoma, but this option is usually explored last. Even if the chemotherapy shrinks the cancer cells, they usually return and start growing again after a few months.
AIM at Melanoma provides more detailed information regarding specific drug treatments available.
Clinical trials for new therapies are where most of the advancements in melanoma treatment, prevention and diagnosis occur. Patients with melanoma should talk to their doctor to see if they are eligible for any clinical trials.