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Melanoma is the most dangerous form of skin cancer. In stages I and II, melanoma may be effectively treated with surgical removal of the lesions.
However, in stage III the melanoma has spread to the lymph nodes that are located close by the lesion. In stage IV, it has spread to lymph nodes that are farther away and to other internal organs. Advanced stages of melanoma are more difficult to treat.
According to MD Anderson Cancer Center, about 8 percent of patients with melanoma are diagnosed as stage III. They have a 5-year relative survival rate of about 62 percent.
Patients who present with stage IV, metastatic disease, have a 5-year survival rate of only about 16 percent. Only 4 percent of melanoma patients are diagnosed as stage IV.
In stage III, removal of the lesion and a wide area of normal skin surrounding the lesion is standard treatment. Lymph nodes will also be removed in the area close to the melanoma site.
Depending on what subclass of stage III melanoma has been determined, various therapies may be tried.
Immunotherapy
Immunotherapy with Interferon may be used as an added protective measure. If there are several melanomas then other immunotherapies such as a Bacille Calmette-Guerin (BCG) vaccine, interferon-alpha, or interleukin-2 (IL-2) may be tried.
Some immunotherapies have serious side effects so may not be appropriate for everyone.
Targeted therapy
Targeted therapy is a method of treating the gene changes that make skin cells turn into melanoma cells. Targeted therapy may work when chemotherapy doesn’t, and it may have fewer side effects.
Half of melanoma changes come from mutations of the BRAF gene. Drugs can target this gene if a person’s BRAF gene shows abnormalities. Use of other drugs can affect the MEK gene and C-KIT gene.
Radiation therapy
Radiation therapy uses high energy x-rays and may be used in areas where lymph nodes were removed, to treat recurrent melanoma or to shrink tumors to increase comfort.
Stereotactic radiosurgery (SRS) is a special radiation therapy that is used to treat brain tumors. It is not actually surgery but uses a machine called a Gamma Knife® which focuses about 200 beams of radiation on the tumor from different angles
Chemotherapy
Chemotherapy uses drugs to kill the cancer cells. Chemotherapy may be tried after using newer forms of immunotherapy and targeted therapy, as those other types of treatments have been found to be more effective to treat advanced melanoma.
Stage IV melanomas are very hard to cure, as they have already spread to distant lymph nodes or other areas of the body.
As with stage III, surgery may be used in stage IV to remove the melanoma lesion, surrounding skin, lymph nodes close by, lymph nodes farther away and any organs that the melanoma has spread to.
Any metastasis that cannot be removed may be treated with radiation, immunotherapy, targeted therapy or chemotherapy.
Newer forms of immunotherapy, such as ipilimumab (Yervoy), have been shown to help some people with advanced melanoma live longer. Targeted therapies like those that tackle BRAF gene changes may also help patients to live longer.
Chemotherapy may help to shrink tumors. Biochemotherapy, which is a combination of both chemotherapy and immunotherapy, may be tried.
In stage IV melanoma, treatment is more directed towards extending one’s life since finding a cure is so difficult.
Clinical Trials
Clinical trials are another avenue for those with advanced stage melanoma. These are research controlled opportunities for patients to try newer discovered drugs. Talk to your doctor about how to find out about clinical trials that may be suitable for you.
Go here for more information about clinical trials. And go here to search for ones you may qualify for.
It is important to consult with your doctor and your family before starting any treatments for advanced melanoma. Do not hesitate to get a second opinion.
Come up with a plan that you are comfortable with and do your best to understand the benefits and risks of each of the treatments available.
Resources:
Sources:
Treatment of melanoma skin cancer by stage. American Cancer Society. Retrieved Dec. 6, 2014.
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-...
Immunotherapy for melanoma skin cancer. Retrieved Dec. 6, 2014. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-...
Targeted therapy for melanoma skin cancer. Retrieved Dec. 6, 2014.
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-...
Chemotherapy for melanoma skin cancer. Retrieved Dec. 6, 2014.
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-...
Guide to Staging—Melanoma. Skin Cancer Foundation. Retrieved Dec. 6, 2014.
http://www.skincancer.org/skin-cancer-information/melanoma/the-stages-of...
Metastatic Melanoma. MD Anderson Cancer Center. Retrieved Dec. 6, 2014.
http://www2.mdanderson.org/depts/oncolog/articles/11/1-jan/1-11-compass....
Stage IV Melanoma. Stage IV Melanoma. Retrieved Dec. 6, 2014.
http://www.aimatmelanoma.org/en/aim-for-answers/stages-of-melanoma/stage...
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues.
Edited by Jody Smith
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