Treating Stage Iii Melanoma
These cancers have already reached the lymph nodes when the melanoma is first diagnosed. Surgical treatment for stage III melanoma usually requires wide excision of the primary tumor as in earlier stages, along with lymph node dissection.
After surgery, adjuvant treatment with an immune checkpoint inhibitor or with targeted therapy drugs may help lower the risk of the melanoma coming back. Other drugs or perhaps vaccines may also be recommended as part of a clinical trial to try to reduce the chance the melanoma will come back. Another option is to give radiation therapy to the areas where the lymph nodes were removed, especially if many of the nodes contain cancer.
If melanoma tumors are found in nearby lymph vessels in or just under the skin , they should all be removed, if possible. Other options include injections of the T-VEC vaccine , Bacille Calmette-Guerin vaccine, or interleukin-2 directly into the melanoma radiation therapy or applying imiquimod cream. For melanomas on an arm or leg, another option might be isolated limb perfusion or isolated limb infusion . Other possible treatments might include targeted therapy , immunotherapy, or chemotherapy.
Some people with stage III melanoma might not be cured with current treatments, so they may want to think about taking part in a clinical trial of newer treatments.
What Is Radiation Therapy
After surgery your doctors may recommend radiation therapy to help improve your outcome.
Radiation therapy uses x-rays to kill cancer cells by damaging their DNA. Normal cells can repair damage to their DNA, but cancer cells are less able to do this and therefore die. The dead cancer cells are then broken down and eliminated by the bodys natural processes.
Since radiation therapy damages normal cells as well as cancer cells, treatment must be carefully planned to allow the normal cells to repair themselves and minimise side effects.
The total dose of radiation and the number of treatments you need will depend on the size and location of your melanoma, your general health and other medical treatments youre receiving.
The radiation used for cancer treatment can come from a machine outside your body or it might come from radioactive material placed in your body near the cancer cells.
Who Treats Melanoma Skin Cancer
Depending on your options, you may have different types of doctors on your treatment team. These doctors may include:
- A dermatologist: a doctor who treats diseases of the skin
- A surgical oncologist : a doctor who uses surgery to treat cancer
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy, immunotherapy, or targeted therapy
- A radiation oncologist: a doctor who treats cancer with radiation therapy
Many other specialists may be involved in your care as well, including physician assistants , nurse practitioners , nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
Recommended Reading: Ductal Invasive Carcinoma Survival Rate
Skin Exam And Physical
If youve been diagnosed with melanoma, youve already had a skin biopsy. This biopsy was taken when you had part of the suspicious spot removed. After it was removed, a doctor looked at the spot under a microscope to find out if it contained cancer cells. This is currently the only way to tell if someone has skin cancer.
After getting the diagnosis, the next step is to get a complete skin exam and physical.
During the physical, your dermatologist will feel your lymph nodes. This is where melanoma usually goes when it begins to spread. It usually travels to the lymph nodes closest to the melanoma.
If there is a risk the cancer could have spread, your dermatologist may recommend that you have a lymph node biopsy. If a sentinel lymph node biopsy is recommended, it can be performed at the time of your surgery for melanoma.
After the skin exam and physical, your dermatologist may recommend testing, such as a CAT scan, MRI, or a blood test. These can also help detect spread.
How Is Lentigo Maligna Melanoma Diagnosed
After reviewing your medical history and doing a physical exam, your doctor may refer you to a dermatologist or other specialist. They may use a dermatoscope, which combines a magnifying lens with a bright light, to get a better look at the spot. Your doctor may also do a biopsy. This involves removing all or a piece of the spot to see if it has cancer cells.
If the spot seems like its lentigo maligna melanoma, your doctor may also do a sentinel lymph node biopsy to see how far its spread: They first remove some nearby lymph nodes, and then have them tested for cancer. A CT scan or MRI scan can also show any signs of spreading.
If youre diagnosed with lentigo maligna melanoma, your doctor will determine its stage, which reflects how serious it is. Breslows thickness, which is the thickness of the spot, helps determine the stage of skin cancer. The Clark level of invasion, which is how many skin layers are involved in the cancer, can also help determine the cancers stage. The stages of skin cancer range from 0 to 4, with 0 being the earliest stage.
Recommended Reading: Can You Cure Stage 4 Melanoma
Treatments Below The Surface
If the tumor has grown deep into your skin or spread to other parts of your body, treatment is more complex. You might need surgery to remove lymph nodes near the melanoma to see if the cancer has spread there. For example, if the problem is on your arm, the surgeon might take out the lymph nodes under your armpit. For larger tumors, you might have to stay in the hospital overnight.
Other options are:
Immunotherapy. This approach uses drugs that help your immune system find and attack cancer cells. You might get them in a shot or go to a treatment center or hospital to get them through an IV every 2-4 weeks. If the melanoma is on your face, your doctor might prescribe a cream that revs up the immune cells only around the tumor, instead of in your whole body like the other drugs.
Sometimes, immunotherapy drugs can make your body attack your healthy organs. If that happens, youâll need to stop taking them and get other treatments to stop the attack.
Chemotherapy. These drugs travel through your body and attack cancer cells. Some chemotherapy drugs are pills, and others you get through an IV. Although chemo won’t cure melanoma, it can relieve symptoms and it may help you live longer. It sometimes works better when you also take immunotherapy drugs. If your cancer is only in your arm or leg, you may get chemotherapy in just that limb. Doctors call this treatment “isolated limb perfusion.”
- Rash
- Swelling
Some people take both MEK and BRAF inhibitors.
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.
Also Check: What Are The Forms Of Skin Cancer
How Then Do You Know Which Type Of Doctor You Should Be Seeing
The type of doctor to treat your skin cancer may depend on the type of your skin cancer or even the location of your skin cancer. Also, you may end up with a medical team, comprised of more than one type of doctor, to treat your skin cancer.
Lets do a basic overview of how each type of medical provider may participate in your skin cancer journey.
Complementary And Alternative Treatments
It’s common for people with cancer to seek out complementary or alternative treatments. When used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve your quality of life. Others may not be so helpful and in some cases may be harmful. It is important to tell all your healthcare professionals about any complementary medicines you are taking. Never stop taking your conventional treatment without consulting your doctor first.All treatments can have side effects. These days, new treatments are available that can help to make many side effects much less severe than they were in the past.
You May Like: Does Amelanotic Melanoma Blanch When Pressed
New Types Of Treatment Are Being Tested In Clinical Trials
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Vaccine therapy
Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied in the treatment of stage III melanoma that can be removed by surgery.
Permission To Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .
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.
Also Check: Squamous Cell Carcinoma Scalp Prognosis
Surgical Removal Of The Melanoma
Treating early melanoma
Stage 0 in situ and stage I
Tumors discovered at an early stage are confined to the upper layers of the skin and have no evidence of spread. These melanomas are treated by excisional surgery. Usually, this is the only treatment required. The first step was a biopsy, where the physician removed part or all of the lesion and sent it to a lab for analysis, where the melanoma was diagnosed and staged. For the excisional surgery, the surgeon removes more tissue from the site.
Melanoma in situ is localized to the outermost layer of skin . Stage I melanoma has invaded the second layer of skin . In both stage 0 and stage I melanoma cases, the physician uses a scalpel to remove any remaining tumor plus a safety margin of surrounding normal tissue. The margin of normal skin removed depends on the thickness and location of the tumor. After surgery the margins are checked to make sure they are cancer-free. If the margins are cancer-free, no further surgery is necessary.
Surgeons may, under certain circumstances, recommend removal of melanoma by Mohs surgery. The procedure is done in stages over a few days to remove all of the cancer cells in layers while sparing healthy tissue and leaving the smallest possible scar. One layer at a time is removed and examined until the margins are cancer-free. New advances in this technique make it easier for the surgeon to spot melanoma cells in the margins.
Treating intermediate, high-risk melanomas
Stage II
Things To Consider When Selecting Your Doctor:
- Are they part of your health insurance network?
- Are they convenient to get to?
- Does the doctor seem like a good fit in terms of personality and communication style?
- Does the doctors office offer supportive services, such as help with nutrition?
- Does the doctor participate in research studies? Do they support patient participation in clinical trials?
Recommended Reading: When Squamous Cell Carcinoma Spreads
What Is The Role Of The Oncologist
An oncologist manages a patientâs care throughout the course of the disease. This starts with the diagnosis. Their role includes:
-
Recommending tests to determine whether a person has cancer
-
Explaining a cancer diagnosis, including the type and stage of the cancer
-
Talking about all treatment options and your treatment choice
-
Delivering quality and compassionate care
-
Helping you manage symptoms and side effects of cancer and its treatment
A personâs cancer treatment plan may include more than one type of treatment, such as surgery, cancer medications, and/or radiation therapy. That means different types of oncologists and other health care providers work together to create a patientâs overall treatment plan. This is called a multidisciplinary team. Cancer care teams often include a variety of other health care professionals, including pathologists, radiologists, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, and more. Learn about these and other possible members of a multidisciplinary team in another article on this website. Doctors from other areas of medicine can also be part of this team. For example, a dermatologist, which is a specialist in skin problems, may help treat skin cancer.
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.
You May Like: Where Can Skin Cancer Spread
Don’t Miss: Can You Die From Basal Cell Skin Cancer
What Are The Complications Of Lentigo Maligna Melanoma
Untreated lentigo maligna melanoma can eventually spread throughout the body, so identifying it as early is possible is important. The more the cancer spreads, the harder it is to treat.
Surgery to remove lentigo maligna melanoma may have cosmetic complications because it usually occurs on highly visible areas such as the face. Tell your doctor if youre worried about this. Depending on where the cancer is, they may be able to minimize the scar using a variety of surgical techniques.
Can Melanoma Be Prevented
No one can prevent melanoma entirely: sometimes it happens because of a genetic mutation, which is beyond your control. However, some melanomas are related to sunlight and here are some tips to help prevent it:
- You should never use tanning beds or artificial tanning machines: they expose your skin to very strong UV light and have been linked to skin cancer.
- Staying indoors or in the shade as much as possible between 11 am and 3 pm.
- Try not to get sunburnt at all.
- Covering up with clothes and a wide-brimmed hat when out in the sunshine.
- Applying sunscreen with a sun protection factor of 15 which also has high ultraviolet A protection.
These tips are particularly relevant to children and teenagers – particularly teenagers who might be tempted to use sun tanning booths: don’t do it.
However, avoiding all sunlight is generally not a good idea and, even if you have a family history of melanoma, probably won’t reduce your risk to zero.
Read Also: Melanoma Bone Cancer Symptoms
What Is The Outlook
The outlook for people with malignant melanomas has been improving over a period of 25 years and people with melanomas now have amongst the best outlook for any cancer. Around three quarters of people who have a melanoma removed will have no further problems.
The outlook depends on the stage. Most cases of stage 1 melanoma are cured with a minor surgical operation to remove the tumour . For people with deeper melanomas then there is still a chance of cure. People with advanced melanoma that has spread to other parts of the body are not likely to be cured. However, treatment can often slow down the progression of the cancer.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your type and stage of cancer are likely to respond to treatment.
The Stage Of Melanoma Depends On The Thickness Of The Tumor Whether Cancer Has Spread To Lymph Nodes Or Other Parts Of The Body And Other Factors
To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.
The stage of melanoma depends on the following:
- The thickness of the tumor. The thickness of the tumor is measured from the surface of the skin to the deepest part of the tumor.
- Whether there are:
- Satellite tumors: Small groups of tumor cells that have spread within 2 centimeters of the primary tumor.
- Microsatellite tumors: Small groups of tumor cells that have spread to an area right beside or below the primary tumor.
- In-transit metastases: Tumors that have spread to lymph vessels in the skin more than 2 centimeters away from the primary tumor, but not to the lymph nodes.
Recommended Reading: Can You Die From Basal Cell Skin Cancer