How is melanoma treated?

Most melanomas are found at an early stage and are treated by surgery alone. For more advanced melanoma, treatments may include radiation treatment, chemotherapy and immunotherapy. You may have one of these treatments, or a combination.

Your doctor will advise you on the best treatment for your melanoma. This will depend on the melanoma thickness, how far it has spread, your general health, your age and your wishes.

The treatment team

From the time you are first diagnosed with melanoma, you may be cared for by one or more of a team of health professionals including:

• your family doctor, who will often be the first person you see
• dermatologists, who specialise in the diagnosis and treatment of skin disorders
• surgeons, who specialise in surgery. You may see a plastic surgeon, who reconstructs affected parts of the body.

If you need further treatment your team may include:

• medical oncologists, doctors who are responsible for chemotherapy and other aspects of cancer care
• radiation oncologists, doctors who specialise in the use of radiation in the treatment of cancer
• radiation therapists, people who prepare you and give your radiation treatment
• oncology nurses, who will help you through all stages of your cancer experience
• dietitians, who will recommend the most suitable foods to eat
• social workers, physiotherapists and occupational therapists, who will advise you on the support services available and help you get back to normal activities.

Ideally, your hospital will have all available means of diagnosis and treatment, although this may not be possible in some rural areas.

Surgery for melanoma

Melanomas are usually removed by surgery. The melanoma is cut out, along with a small area of normal-looking skin from around the melanoma, called the ‘margin’. If the melanoma is at an early stage, the whole melanoma is removed at the initial biopsy.

In many cases more surgery may be required to remove a wider margin of surrounding skin. This increases the likelihood that all melanoma cells have been removed.

These procedures are usually done under local anaesthetic as a day procedure, but it may require admission to hospital and a general anaesthetic. In most cases, the wound can be stitched together and will heal as a straight scar.

Skin grafts

Sometimes, a skin graft is required to cover the wound. For the graft, the surgeon will take a layer of skin from another part of your body and place it over the wound. The other possibility is a ‘flap’, where the surgeon will close the wound using a nearby flap of skin.

Either way, the wound will be covered with a dressing and left undisturbed for several days. It will then be checked to see if it is healing properly. You will also have dressings on any area from which the skin was taken for a graft.

After the operation

You may be uncomfortable for some days after your operation. If you have pain, your doctor should prescribe painkillers for you. If you have a skin graft, the area where the skin is grafted may look unattractive immediately after the operation. Eventually this should heal and the redness will fade.

There is a small risk of infection, haematoma (bruising) and scarring following surgery for melanoma. Occasionally, the skin graft fails.

The majority of people treated for early stage melanoma have surgery only.

Sentinel node biopsy and dissection

If your melanoma is more than 1mm in thickness, your surgeon may suggest you have a sentinel node biopsy at the time of your surgery. A sentinel node biopsy locates the first lymph node that drains from the area where the melanoma developed. This node is detected after injecting a blue dye and a radioactive tracer into the skin where the melanoma was removed.

The first lymph node this reaches is then removed surgically so the node can be examined. If melanoma cells are found in the node/s, the entire group of nodes in that area may be surgically removed (known as a Block dissection).

Radiation treatment

Radiation treatment uses radiation to kill melanoma cells. The radiation can be precisely targeted onto melanoma sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue. It may be given to shrink the tumour and/or to reduce the likelihood of recurrence within the area being treated.

The treatment is usually given over several weeks. The length of treatment will depend on the size and type of the cancer and on your general health. Also see radiation treatment

Side effects of radiation treatment

Side effects of radiation treatment depend on the part of the body being treated. Radiation treatment for melanoma usually involves treatment to the skin and nearby lymph nodes. Side effects may include skin reddening similar to sunburn. Other effects may occur, depending on where your treatment is.

Talk with your doctor or the radiation treatment staff about any possible side effects and how to manage them. Follow the skincare advice given to you by your treatment team.

Lymphoedema

A potential side effect of a lymph node removal and/or radiation treatment to lymph nodes is lymphoedema. Lymphoedema is a swelling in the part of the body drained by the affected lymph nodes.

The best treatment for lymphoedema is a specialised programme of exercise, massage, skin care and a properly fitted support garment or bandage. Contact your local Cancer Society for information on prevention of lymphoedema and details of lymphoedema therapists available in your area.

Chemotherapy

Chemotherapy is the treatment of cancer with special anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.

Chemotherapy can be given before or after surgery and is usually given by injecting the drugs into a vein (intravenous treatment). There are other ways of having chemotherapy, including tablets.

For multiple melanoma nodules confined to the limb, chemotherapy may be given directly into the limb blood vessel. This is called limb infusion/perfusion.

Chemotherapy is occasionally used as palliative treatment for melanoma that cannot be treated by other methods. Currently, chemotherapy does not often cure melanoma.

Side effects of chemotherapy

Some drugs used in chemotherapy can cause side effects. The side effects are specific to the chemotherapy drug(s) chosen.

Side effects may include the risk of infection, feeling sick (nausea), vomiting, feeling ‘off-colour’ and tired, and some thinning or loss of hair from your body and head. Generally, these side effects are temporary.

Talk to your treatment team about how to manage them. Also see chemotherapy side effects

If you develop a fever (have a temperature of 38 degrees Celsius or over), or you feel unwell, even with a normal temperature, do not wait to see what happens. Phone your cancer treatment centre, oncologist, oncology nurse or hospital immediately for advice.

Immunotherapy

Most of the current research into melanoma is in the area of immunotherapy.

Immunotherapy is a treatment to stimulate the body’s normal cells to attack cancer cells. It encourages the body’s natural defence system (the immune system) to attack cancer cells. Biological therapy is another name for immunotherapy.

Clinical trials are testing the effectiveness of other types of immunotherapy such as vaccines. Ask your doctor if you are eligible for a clinical trial.

Side effects of immunotherapy

Interferon is currently the most commonly used immunotherapy treatment in New Zealand for melanoma that has a higher risk of reoccurrence. Interferon is given by injection. The most common side effects are flu-like symptoms and fatigue.

Palliative treatment for advanced cancer

Palliative treatment relieves or reduces symptoms of illness, including pain. It aims to improve quality of life. General practitioners, specialists and palliative care teams in hospitals or hospices all provide palliative treatment for people with cancer.

Taking part in a clinical trial

Research into the causes of melanoma and ways to prevent, detect and treat melanoma continues. Your doctor may suggest you consider taking part in a clinical trial.

It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.

Check-ups after treatment

Following your treatment, you will need to have regular check-ups. As well as a physical examination of your skin, an important part of your regular check-up will be an examination of your lymph nodes. This is one way of finding out if the melanoma has spread. The entire skin surface should be examined under a good light. Your doctor may use a dermoscope (a hand-held magnification device) to look closely at the skin.

It is important that you be shown how to check your own skin and to do it regularly. If you notice any changes in your skin or in your general health, contact your doctor.

Ongoing check-ups may be recommended for life. People who have had one melanoma are at increased risk of another melanoma in the future.

Family risk – it may be helpful for all immediate family members to have a full skin check. If you have close relatives who have had melanoma, talk to your GP about your family’s risk. 

When your treatment is over, you may find it helpful to continue in or join a cancer support group.

Protecting your skin

If you have had melanoma, protect your skin from strong sunlight all year round.

Never allow your skin to burn. Do not rely on sunscreen alone. UV (ultraviolet) radiation levels are particularly high between September and April.

Use a combination of ways to protect your skin:

• Stay out of the sun at times when UV radiation is high.
• Wear sun-protective clothing; for example, long-sleeved shirts with collars and longer pants.
• Protect your face, neck, and ears with a broad-brimmed hat.
• Always wear a broad spectrum SPF 30+ sunscreen on skin that is not covered.
• To protect your eyes from UV radiation, always wear UV protective sunglasses in strong sunlight.
• Stay in shade as much as possible when outdoors.
• Never use sunbeds, tanning booths or tanning lamps.

If you have had melanoma, and are concerned about your vitamin D levels (the main source of vitamin D is sunlight), talk to your doctor.

Relationships and sexuality

For some people, having cancer and treatment for it has no effect on their sexuality. However, the anxiety and/or depression felt by some people after diagnosis or treatment can affect their sexual desire. Also see cancer and sex

Talk to someone you trust if you are experiencing ongoing problems with sexual relationships. Friends, family members, nurses or your doctor may be able to help. Your local Cancer Society can also provide information about counsellors who specialise in sexual counselling.

Fertility and contraception

You may become infertile, either temporarily or permanently, during some treatments. Talk to your doctor about this before you start treatment. Also ask about the need for contraception, as some treatments can increase the risk of miscarriage or birth defects.

If you are pregnant now, talk to your doctors about it straight away.

Orignal material provided by the Cancer Society of New Zealand, 2010. Reviewed by everybody, July 2010.