What Is The Treatment For Melanoma

Mistaken For A Bruise

Many people first mistake subungual melanoma as a bruise.3,4 However, unlike a bruise, the streaks from subungual melanoma do not heal or grow out with the nail over time.4 It can also be confused with normal pigmentation of the nail bed or a fungal infection.2 While you can have a streak or bruising under the nail that isnt melanoma, you should ask a dermatologist to check your nails if you notice any changes.

Treatment Of Stage Ii Melanoma

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage II melanoma may include the following:

• Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
• A clinical trial of new types of treatment to be used after surgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Signs Of Melanoma Include A Change In The Way A Mole Or Pigmented Area Looks

These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:

• A mole that:
• changes in size, shape, or color.
• has irregular edges or borders.
• is more than one color.
• is asymmetrical .
• itches.
• oozes, bleeds, or is ulcerated .

For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.

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Plan For Close Follow

Because melanoma on the head or neck can be aggressive, its important to keep all of your follow-up appointments.

During these appointments, you will have a thorough cancer check-up. You may also have testing, such as a MRI or another type of scan and blood tests. Keeping all of your follow-up appointments allows your doctors to find melanoma as soon as possible. The earlier the cancer is found, the better your outcome.

Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

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What Tests Are Used To Stage Melanoma

There are several tests your doctor can use to stage your melanoma. Your doctor may use these tests:

• Sentinel Lymph Node Biopsy: Patients with melanomas deeper than 0.8 mm, those who have ulceration under the microscope in tumors of any size or other less common concerning features under the microscope, may need a biopsy of sentinel lymph nodes to determine if the melanoma has spread. Patients diagnosed via a sentinel lymph node biopsy have higher survival rates than those diagnosed with melanoma in lymph nodes via physical exam.
• Computed Tomography scan: A CT scan can show if melanoma is in your internal organs.
• Magnetic Resonance Imaging scan: An MRI scan is used to check for melanoma tumors in the brain or spinal cord.
• Positron Emission Tomography scan: A PET scan can check for melanoma in lymph nodes and other parts of your body distant from the original melanoma skin spot.
• Blood work: Blood tests may be used to measure lactate dehydrogenase before treatment. Other tests include blood chemistry levels and blood cell counts.

Expert Review And References

• American Society of Clinical Oncology. Melanoma. 2015: .
• Cancer Care Nova Scotia. Guidelines for the Management of Malignant Melanoma. 2013: .
• National Cancer Institute. Melanoma Treatment for Health Professionals . 2016: .
• National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Melanoma . 2016.
• Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Melanoma. 2015: .
• Ribas A, Slingluff Cl Jr, Rosenberg SA. Cutaneous melanoma. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 94:1346-1394.

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How Do They Work

Messages are sent inside the cell by a series of molecules that tell the cell how to grow and divide. This process is called a signalling pathway.

Mutations, or abnormalities, in these signalling pathways can cause cells to rapidly divide and replicate out of control, resulting in tumour formation. The mutated signalling pathways in melanoma cells are the targets for therapy.

Not all melanomas have the same driving mutations. By identifying which molecules are mutated in different forms of the disease patients can be categorised and treated based on their specific mutation. Identifying all of these molecular mutations is what molecular oncology researchers around the world are working on.

Targeted Therapies Currently Available

Currently, there are three targeted therapy regimens that are approved for use in Australia in patients with a BRAF mutation. These regimens combine a drug that targets the BRAF gene mutation with a drug that blocks the MEK gene .

The combination of a BRAF inhibitor and a MEK inhibitor has been found to be more effective for shrinking melanoma tumours than using either type of drug on its own.

The combinations are:

• a BRAF inhibitor called dabrafenib and a MEK inhibitor called trametinib
• a BRAF inhibitor called vemurafenib and a MEK inhibitor called cobimetinib
• a BRAF inhibitor called encorafenib and a MEK inhibitor called binimetinib.

There are currently no therapies approved specifically to treat NRAS-mutant or cKIT-mutant melanomas, although some are being tested in clinical trials.

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Protect Your Skin From The Sun

Anyone who has had melanoma has a higher risk of getting another skin cancer, including melanoma.

Research shows that people who have had melanoma can decrease their risk of getting another skin cancer by protecting their skin from the sun. Despite this finding, studies have found that many people who have been treated for melanoma dont protect their skin from the sun.

You can reduce your risk of getting melanoma or another skin cancer by:

• Wearing sun-protective clothes, such as a long-sleeved shirt, pants, and a wide-brimmed hat, along with UV-protective sunglasses.

• Staying in the shade while outdoors.

• Planning outdoor activities so that you avoid being outdoors between 10:00 a.m. and 2:00 p.m., when the suns rays are the strongest.

• Applying a broad-spectrum sunscreen with SPF 30 or higher to all skin that clothing wont cover, even when its cloudy or cold outside.

• Using sunscreen every day, even when youll be outside for a short time, such as when you go to work or run errands.

• Avoiding tanning, both indoors and outside.

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer.

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Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

There Are Different Types Of Treatment For Patients With Melanoma

Different types of treatment are available for patients withmelanoma. Some treatments arestandard , and some are being tested inclinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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How Common Is Melanoma

Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. Its one of the most common cancers in young people under 30, especially in young women.

Melanoma incidence has dramatically increased over the past 30 years. Its widely accepted that increasing levels of ultraviolet exposure are one of the main reasons for this rapid rise in the number of melanoma cases.

Sentinel Lymph Node Biopsy

A sentinel lymph node biopsy is a procedure to test for the spread of cancer.

It may be offered to people with stage 1B to 2C melanoma. It’s done at the same time as surgical excision.

You’ll decide with your doctor whether to have a sentinel lymph node biopsy.

If you decide to have the procedure and the results show no spread to nearby lymph nodes, it’s unlikely you’ll have further problems with this melanoma.

If the results confirm melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required.

Additional surgery involves removing the remaining nodes, which is known as a lymph node dissection or completion lymphadenectomy.

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The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

Images in this summary are used with permission of the author, artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Clinical Trials For Melanoma

As part of our commitment to bringing patients new and innovative treatment options for melanoma and other cancers, Cancer Treatment Centers of America® may suggest clinical trials to qualifying patients.

In many cases, clinical trials are intended for patients with advanced cancer, those who have not responded to standard-of-care treatments or patients who may have run out of other treatment options. However, patients may qualify for a clinical trial at any stage of their disease and/or treatment.

Talk to your doctor about whether a clinical trial is an option for you and ask about the risks and requirements involved.

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There Are Three Ways That Cancer Spreads In The Body

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

How Do Dermatologists Diagnose Melanoma

When you see a board-certified dermatologist, your dermatologist will:

• Examine your skin carefully

• Ask questions about your health, medications, and symptoms

• Want to know if melanoma runs in your family

If any spot on your skin looks like skin cancer, your dermatologist will first numb the area and then remove all of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.

Having a skin biopsy is the only way to know for sure whether you have skin cancer.

The tissue that your dermatologist removes will be sent to a lab, where a doctor, such as a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.

What this doctor sees while looking at your tissue will be explained in the pathology report, including whether cancer cells were seen. If melanoma cells are seen, the report will include many important details, including:

• The type of melanoma

• How deeply the melanoma tumor has grown into the skin

• How quickly the melanoma cells are growing and dividing

If its possible to tell the stage of the melanoma, the report will include this information.

Stages of melanoma

Heres an explanation of what each stage of melanoma means:

Stages of melanoma

Stage 0

The melanoma has spread to either: One or more nearby lymph node Nearby skin

Once the stage is known, the next step is treatment.

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Recurrence In Nearby Lymph Nodes

If nearby lymph nodes werenât all removed during the initial treatment, the melanoma might come back in these lymph nodes. Lymph node recurrence is treated by lymph node dissection if it can be done, sometimes followed by adjuvant treatments such as radiation therapy and/or immunotherapy or targeted therapy . If surgery is not an option, radiation therapy or systemic treatment can be used.

Prevention Of Malignant Melanoma

The focus of melanoma prevention is avoidance of sun exposure. Everyone, especially those individuals at high risk of developing a melanoma, should wear protective clothing, avoid peak sun hours, protect children against exposure to ultraviolet radiation, avoid tanning booths, and wear sunscreen with a sun protection factor of at least 15.

This last recommendation is considered somewhat controversial, because no study has shown sunscreen to reduce the incidence of melanoma. Moreover, a systematic review found that sunscreen use leads to longer duration of intentional sun exposure, and sunburns tend to be more frequent among sunscreen users.

In addition, a study of 499 white children who were enrolled at birth or at age 6 and stratified colorimetrically by skin tone found no association between sunscreen use and the overall number of moles at the age of 15 years. The only significant association was for lighter-skinned children who had at least three sunburns at 12 to 14 years old, who had fewer moles if they used sunscreen. However, even that association might have occurred by chance.

First-degree relatives of a patient diagnosed with familial melanoma should be encouraged to have annual skin examinations.

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Risk Of Further Melanomas

Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups. Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems. After treatment for melanoma it is important to limit exposure to the sun’s UV radiation. As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times. It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.

Treatment Of Melanoma With Braf Mutations

BRAF mutations are present in 60% of melanomas. Detection of this mutation is important prior to starting treatment in any melanoma patient. In a multicenter, phase I, dose-escalation trial, 32 patients with metastatic melanoma who had a BRAF mutation were treated with vemurafenib . Two patients had a complete response and 24 had a partial response.

First-line treatment of patients with BRAF V600 wild-type or mutation-positive, unresectable or metastatic melanoma is with nivolumab as a monotherapy or in combination with ipilimumab.

Vemurafenib was approved by the FDA in August 2011. It is an inhibitor of some mutated forms of BRAF serine-threonine kinase, including BRAF -V600E. This agent is indicated for the treatment of unresectable or metastatic melanoma with BRAF-V600 mutation as detected by the cobas 4800 BRAF V600 Mutation Test . Vemurafenib has not been studied with wild-type BRAF melanoma.

In May 2013 the FDA approved dabrafenib , a BRAF inhibitor in the same class as vemurafenib, for patients with unresectable or metastatic melanoma with BRAF V600E mutation confirmed by the THxID BRAF mutation test. In a multicenter, open-label, phase III randomized controlled trial, treatment with dabrafenib significantly improved progression-free survival in patients with BRAF-mutated metastatic melanoma, compared with dacarbazine .

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