Melanoma and Other Skin Cancers - References

Treatment for Melanoma

Treatment for melanoma depends on various factors, including:

• The site of the original lesion
• The stage of the cancer
• The patient's age and general health

Treatment options include:

• Surgery to remove the tumor or tumors
• Chemotherapy
• Immunotherapy
• Radiation therapy
• Symptom relief (palliative therapy)

Surgery

Surgery is the primary treatment for all stages of melanoma. Some or all of the melanoma is often removed during the first biopsy. If cancerous tissue still remains after such a biopsy, a surgeon will cut away additional tissue from the surrounding area to remove any stray cancer cells.

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Surgical management of melanoma that develops in rare sites, such as the vagina, cervix and ovaries, is becoming less aggressive. Studies have shown that wide local removal is equal to radical surgery in many of these cases. Melanoma of the urethra, bladder and ureter usually requires extensive surgery, however.

Mohs micrographic surgery is a technique used to remove very thin layers of skin, one at a time. Each layer is examined immediately under a microscope. When the layers are shown to be cancer-free, the surgery is complete.

The amount of tissue removed depends on the size, depth, and degree of invasion:

• Stage I lesions that are less than 1 mm deep require the smallest surgical cuts, usually about 1 cm off each side and downward from the original lesion.
• For melanomas that are 2 mm or thicker, a margin of 3 cm is important for reducing the risk that the cancer will return.
• Thicker lesions require wider surgical cuts.

Doctors used to remove a large area, regardless of the cancer stage. This potentially disfiguring approach has been abandoned because studies have shown that removing wider margins does not improve survival. Nevertheless, sometimes skin grafts may need to be taken from other body sites to help cover the wound.

Lymph Node Removal. If there is evidence that melanoma has spread to nearby lymph nodes but has not spread beyond them, removing those lymph nodes may reduce the chance of recurrence and help patients live longer.