To diagnose melanoma, a doctor will take your medical history and perform a physical exam. If melanoma is suspected, your doctor will take a biopsy—usually right in the office—(either of the entire mole or a small sample of it) to confirm the cancer. If it is melanoma, the skin sample may be studied further to look for specific features that may provide information about prognosis.
If your doctor suspects that the melanoma has spread deeper into the skin, she or he may order other tests such as a biopsy of nearby lymph nodes, x-rays, scans, or blood tests.
Following a confirmation of melanoma, your doctor may consult with or refer you to other professionals for treatment, including a dermatologist, plastic surgeon or oncologist.
Generally, the earlier that melanoma is caught, the more successful the treatment will be. However, the outcome will depend on tumour thickness, ulceration and depth, the location of the cancer, the severity (or stage) of cancer, and a person’s age. The less melanoma has grown into the skin, the better the chance of curing it.
There are five common treatments for melanoma:
Surgery to remove the tumour is the main treatment for melanoma at all stages and there are several different types:
- Excision to remove the tumour and surrounding skin
- Sentinel lymph node biopsy to remove the first lymph node likely to be invaded if the melanoma metastasizes
- Lymph node dissection, which removes all lymph nodes close to the tumour, particularly those that can be felt by physical examination; this surgery causes long-lasting, uncomfortable fluid build-up and is done only if necessary
Radiation therapy uses high-energy rays or particles to kill cancer cells. It is most often used in advanced cases of melanoma that have spread to the brain or bones. In external beam radiation therapy, a machine directs radiation to the tumour and surrounding area. Radiation therapy may be used as the therapy of choice if a person’s health will not tolerate surgery, if a recurring tumour’s location or size makes surgical removal cosmetically unacceptable, or if there is a high risk of recurrence. Radiation therapy to lymph nodes can scar lymph nodes and block fluids, leading to fluid build-up.
Chemotherapy uses cytotoxic (cell-killing) drugs to remove cancer cells. Limb perfusion, or isolated limb perfusion, is used to deliver medication directly to the affected limb. With this technique, blood flow to the limb is stopped using a tourniquet and the medication is injected directly into the limb. This may be used to treat melanoma believed to have spread to the arm or leg.
Systemic drug treatments are also used for this type of cancer. Common systemic agents are dacarbazine, given singly by intravenous infusion, and temozolomide, given singly by oral dose, or a combination of vinblastine, cisplatin and dacarbazine (a combination known as CVD) by intravenous infusion.
Biological therapy (immunotherapy) uses natural or manufactured agents to strengthen the immune system. Biological therapy may be used after surgery for melanomas in which the risk of recurrence is high. Interferon, interleukin-2, and Bacilli Calmette-Guerin are the most common biological therapy drugs used for melanoma.
Within each category are a number of treatments and medications. Your doctor will determine the best course of therapy based on your age, stage of melanoma, and other important factors. However, as with any therapy, it is best to understand the treatment you are receiving. Don’t be afraid to ask your doctor any questions you may have.
In addition, researchers are continually exploring new ways to treat melanoma. Some may be conducting research studies known as clinical trials, which test new medications and treatments that are being developed. (For example, a recent study showed that the biological agent ipilimumab nearly doubled the number of patients with advanced cancer surviving for one year.)
*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or a pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not necessarily mean “safe.”