What is the treatment for malignant melanoma?

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Treatment for malignant melanoma depends on several factors, the patient's..:

• Age
• General health
• Stage of cancer
• Personal preferences

A good doctor should set out to the patient all the different available treatments clearly, including their potential risks and side effects. It is sometimes advisable for the patient to seek out a second opinion if he/she is not sure. Some patients decide not to treat the melanoma, but rather to treat the symptoms the cancer is causing - this is more common among patients who have determined that treatment will not significantly extend their life expectancy.

Treating early-stage melanoma treatment - Stage 1 Melanoma

• Surgical removal
  
  In many cases, all that is needed is the removal of the melanoma (surgical excision), and that's it. If the melanoma is very thin it is most likely that all of it was removed during the biopsy and no further treatment is required. Most surgeons will take out the cancer as well as a small border of normal skin and a layer of tissue below the skin to optimize the chances that all the cancer is eliminated.
  
  Surgeons used to more commonly take out a large border of skin and then the patient would have skin graft. However, it seems that if the surgeon takes out smaller amounts of healthy tissue this is just as effective for many cases of invasive melanomas. The advantage of not taking out too much healthy tissue is that a skin graft is not required.

Stages 2 and 3 melanoma treatments

• Surgical removal and possible removal of nearby lymph nodes
  
  As well as removing any affected area of skin, sometimes the surgeon has to remove a nearby lymph nodes as well in case cancerous cells are present there - this is called a block dissection and the patient is given a general anesthetic. If lymph nodes are removed there is a risk that the patient's lymphatic system will be disrupted and he/she can develop lymphedema. Lymphedema patients experience a build-up of fluids in their limbs.


• Interferon
  
  After surgery the patient may be given interferon. Interferon can reduce the chances of melanoma recurrence. Interferon encourages the body's immune system to fight off any remaining cancer cells. Most patients are given three interferon injections each week. Many patients can learn how to inject themselves - meaning they do not have to leave home for treatment. How long this treatment lasts depends on several factors, including how advanced the melanoma is.
  
  Interferon treatment may have the following side effects, which can be quite bad at first:
  
  
  • Chills
  • Fever
  • Joint pain
  • Tiredness (fatigue)
  The following side effects are also possible, but less common:
  • Vomiting
  • Nausea
  • Irritation at injection site
  • Hair loss
  • Pins and needles in the hands and toes
  • Depression
  • Mood changes
  • Infertility
  • Higher susceptibility to infection
  • Alterations in heart rhythm
  • Alterations in blood pressure
  
  After the second and third doses the side effects start to subside. Patients should report any less common side-effects to their doctor, who may consider offering another treatment. Most patients are monitored closely while on interferon treatment, this may include regular blood tests, urine tests, and blood pressure checks.

Stage 4 melanoma treatment

At this point the chances of a cure are improbable. However, it is possible to slow down progression of the cancer and help the patient to live longer. The following treatments are available:

• Interferon treatment (details above in Stage 2 and 3 treatments).


• Chemotherapy - cells are destroyed with the aid of drugs. Doctors will usually administer at least two drugs simultaneously, either intravenously, orally or both. Chemotherapy, which is often resistant to melanoma, is sometimes used to relieve the symptoms of patients with advanced metastatic melanoma.
  
  Side effects may include:
  
  
  • Nausea
  • Vomiting
  • Hair loss
  • Tiredness (fatigue)
  • Weakened immune system
  
  In the vast majority of cases symptoms will subside as soon as treatment has finished.


• Radiation therapy (radiotherapy) - High energy X-rays are targeted at the cancer cells and destroy them. Radiotherapy is also used to relieve symptoms of patients with advanced metastatic melanoma.
  
  Side effects may include:
  
  
  • Tiredness (fatigue)
  • Loss of appetite
  • Hair loss
  • Sore skin
  • Lower libido (lack of interest in sex)
  • Nausea
  
  Side effects may persist for several weeks, or even months after treatment has stopped.


• Clinical trials - some doctors may suggest participating in a clinical trial. A clinical trial is a study of a drug that has not yet been approved by the regulatory authorities. It usually involves a certain number of participants who either take the trial drug, an existing drug, or a placebo. Anyone who enrolls in a clinical trial has the opportunity to try out evolving therapies. The downside is that the outcome is unclear, as well as the side effects. Currently (June 2009) the following therapies are in clinical trials for malignant melanoma: chemoimmunotherapy, gene therapy, targeted therapy, and vaccine treatment.