Treatment of Melanoma

Treatment of Stages

The treatment of a melanoma depends on its size and how it has developed - whether it's localized or has spread to other parts of the body.

If you've been diagnosed with melanoma you will often hear it described in stages.

Treatment Stages 0 and 1

If your melanoma is graded as Stage 0 (also known as carcinoma in situ) the cancer cells are confined to a small, very thin tumor in the very top layer of the skin. Stage 1 melanoma is no bigger than 2 centimeters in diameter and is also localized. If the cancer is found at these stages, all that is generally needed to cure it is complete removal by surgery. This is usually done under local anesthetic and the tumor and some of the surrounding tissue is removed. The wound is then stitched up.

Treatment Stage 2 and 3

When the skin cancer is larger - more than 2cm across - and thicker, it is usually described as Stage 2. Like stages 0 and 1, the melanoma still hasn't spread deeper into the skin and complete removal is likely to cure it. However because the area is larger, it may not be possible to stitch up and a skin graft could be needed. This usually involves taking skin from the thigh area to replace the missing tissue.

Usually at this stage, because the melanoma is bigger the surgeon may also do a sentinel node biopsy to see if the cancer has spread to the lymph nodes. If it has spread, the melanoma is described as Stage 3. The surgeon will usually treat this by removing all the nodes surrounding the cancer in the hope of preventing it from using the lymphatic system as a means of transport to other organs in the body.

Stage 4 Melanoma

By Stage 4, the cancer has spread to other parts of the body. By now the likelihood of a cure is very small and we're talking more about controlling the symptoms and trying to give the patient a better quality of life.

Stage 4 melanoma and, to a lesser degree, Stage 3 melanoma are usually treated the same way.

Surgery can certainly remove the original melanoma tumor and any affected lymph nodes. However, the spread of the melanoma, whether it is to the rest of the lymph nodes with Stage 3, and other organs for Stage 4, means more aggressive treatment with chemotherapy, radiotherapy and/or immunotherapies is needed.

Chemotherapy involves a cocktail of drugs to destroy the cancer cells which have already spread beyond the original melanoma. It is not a cure in Stage 4 melanoma but can relieve symptoms and even prolong life.

If a melanoma reoccurs on the leg or the arm a treatment known as isolated limb perfusion may be used. This is a way of giving the chemotherapy to one area without affecting other parts of the body. It's done under general anesthetic and the blood supply has to be isolated from the area, by temporarily disconnecting it, before introducing the chemo drugs.

Radiotherapy is used more as an adjuvant treatment - i.e. one to prevent the cancer's spread rather than provide a cure. High energy X-rays target a specific area to destroy the cancer cells.

Immunotherapy involves using proteins naturally produced by the body - interferon and Interleukin-2 - to boost the immune system and attack the cancer cells. Both proteins have been found to shrink the melanoma in stages 3 and 4.

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