A guide to melanoma treatment, including re-excision, chemotherapy and immuno therapy.
If you will be undergoing melanoma treatment, you have already received the diagnosis from a mole that was removed. The pathology report can sound grim when it says you have skin cancer, but the outlook for melanoma is excellent if it was caught early, like so many cancers.
Usually, the first treatment after diagnosis is a wide re-excision, also called wide excision. What it means is an area around where the mole was located, will be removed to be certain all the melanoma cells are gone. Particularly, if the margins of the cancer were close to where the original cut was made for the first biopsy, a wide excision is likely to be performed.
The amount of skin to be taken off the site of the mole depends on how large the melanoma was and how close the borders were to the first incision. A parameter of one to two inches in an elliptical shape is typically removed. Depending on the location of the mole, there could be some skin grafting required. Overall, the amount of skin taken off isn't as radical as it used to be now that more research has been done to determine recovery rates with varying degrees of wide excision.
Next, depending on the size of the melanoma, you may only have follow-up visits with your dermatologist and/or oncologist or you may need more thorough treatment. Some doctors want to perform a sentinel node biopsy prior to a wide excision to determine the accurate drainage pattern of the lymphatic system. What this determines is how the lymph system flows around where the melanoma was and thus tells them which way the cancer might be spreading. But, some physicians practice sentinel node biopsy for lesions over 1.0 mm to try to be certain the cancer has not spread.
The goal of the sentinel node biopsy is to detect micrometastases in the lymph nodes. These are melanoma cells which need to be detected with the procedure called lymphoscintigraphy. A radioactive isotope is injected under the skin and then mapped to see where the first draining nodes are located at. Once that is determined the surgical procedure can be done to remove those nodes and send them to pathology to determine if there are melanoma cancer cells present. If no cancer is present, treatment is generally done and follow-up therapy is all that is needed.
If melanoma was found in the sentinel nodes, primary draining lymph nodes, a formal lymph node dissection is done. This is an intensive surgery which results in drainages in place while recovering from the surgery since it is very invasive and more complex than a sentinel node biopsy. What the procedure involves is removing all of the lymph nodes in the region draining the area where the melanoma was. This was determined with the radioactive procedure which located the sentinel nodes.
If melanoma is present in the removed lymph nodes the treatment is significantly more complex. Immunotherapy is likely to be implemented to boost the immune system so it can battle the cancer which could be spreading, metastasizing, to other parts of the body. Residual melanoma cells could be lurking unbeknownst to anyone. One reason for this therapy is that researchers have discovered that patients with melanoma have immune systems unable to recognize the melanoma cells as abnormal or foreign.
The goal is to have treatment attack the melanoma cells as foreign invaders and combat the disease. Cytokines are proteins made in one cell that can do just such a thing. They stimulate immune cells to multiply and travel to the site needing help in the body. Two manufactured cytokines used for melanoma are alpha interferon and interleukin 2.
Alpha Interferon is one of three interferons, alpha, beta and gamma. Alpha is the only interferon which has proven itself against melanoma. Though the results with this have not been as spectacular as hoped, some people have benefited from receiving Alpha Interferon.
On the other hand, Interleukin 2 has proven more successful. It is used to treat advanced melanoma when it has spread to other parts of the body. What this cytokine does is increase the number and fighting power of immune system cells known as T cells and natural killer cells.
Next in line for treatment is radiation. When many lymph nodes are involved, radiation works best. Also, it can reduce the likelihood of local recurrence in the lymph nodes and reduce the chance the melanoma will spread to other internal organs.
Melanoma treatment needs to be rigorous in follow-up no matter what the treatment plan is. Since a small lesion can be invading the lymph system while no one knows it, watching for signs of recurrence or the development of another melanoma is critical in ensuring good chances of survival. Better safe than sorry has never been more accurate than with melanoma treatment.
