The treatment for melanoma depends on three factors: the age of the person, the general health of the person, and the stage of the disease. Surgery is the first treatment for almost all stages of melanoma, with the exception being certain Stage IV patients which often can require additional non-surgical treatments. Early-stage melanoma can usually be treated with surgery alone. This involves a wide excision and sentinel lymph node biopsy.
Melanoma Surgery and Sentinel Lymph Node Biopsy
Melanoma excision and sentinel lymph node biopsy is a surgical procedure highly accurate in determining if there is a metastatic spread to the regional lymph nodes in the area. This is done by “mapping” the skin and determining which lymph node(s) drain that patch of skin. The procedure involves injecting a small amount of radiotracer (or occasionally blue dye) around the melanoma. This involves les radiation than getting a chest x-ray.
The sentinel lymph node (think of it as a gatekeeper lymph node at the entrance to the other lymph nodes) is then identified using a small hend-helf Geiger counter and removed, leaving the remaining lymph nodes intact. The pathology of the sentienl node(s) determines if you need a more extenive lymph node dissection.
This procedure is usually performed in conjunction with wife excision of the skin around the melanoma with subsequent reconstruction. The entire procedure is generaly performed as an outpatient procedure.
Surgery is usually the only treatment needed for people with early-stage melanomas. However, these people still need regular follow up visits to the doctor, to make sure the melanoma has not come back and that other moles do not need biopsies. Once a person has had melanoma, there is a higher chance of getting it again.
For later-stage melanomas (thick melanomas or those that have spread to the nearby lymph nodes), other treatments besides surgery may be needed. These are called “adjuvant treatments”, and they may take the form of: immunotherapy, chemotherapy or radiation therapy. Melanoma that has spread to distant sites in the body, or to other organs (such as the lungs or liver) is known as Stage IV. For these patients treatment options may be available, including clinical trials.
Immunotherapy uses substances similar to the ones that the body’s immune system produces to destroy cancer cells. When you have an infection, your immune system releases many specialized proteins called cytokines. They help fight the infection. Some of these cytokines can also help fight cancer cells. Normally the body produces very small amounts of these cytokines. But it is possible to make large quantities of cancer-fighting cytokines in a laboratory. The two types of immunotherapy used for melanoma are Interferons and Interleukins.
Interferons are proteins produced by your immune system in response to an infection. Interferons work by “interfering” with the foreign invaders (bacteria or viruses) that may cause infection. Interferons can also prevent the growth and spread of other diseased cells, including some types of cancer cells.A man-made version of one type of interferon is approved by the FDA to treat “high-risk” melanomas. It is called INTRON A (Interferon alfa-2b, recombinant) for injection.”High-risk” melanomas are tumors that have a high chance of coming back, or have spread to nearby lymph nodes. A tumor is considered a “high-risk” melanoma if: it is more than 4 mm thick, or it has spread to the body tissue below the skin or to a lymph node.
For full prescribing information on INTRON A click here.
Interleukin 2 (IL-2) is a protein that occurs naturally in your body. It
plays an important role in “switching on” or activating the body’s
immune system. IL-2 activates special defense cells called “T cells”
and “natural killer (NK) cells,” to attack and destroy invading germs or diseases.
IL-2 can also stimulate T cells and NK cells to attack and destroy cancer cells. A man-made version of IL-2, called aldesleukin, is available. It acts like natural IL-2 to help the immune system recognize and destroy certain types of melanoma. This treatment is only meant for patients with advanced melanoma (Stage IV) that has spread far from the original site, or to other organs (such as the lungs or liver).