Booklet: What You Need to Know about Skin Cancer
Update: July 1999

Treatment Option Overview

How melanoma is treated

There are treatments for all patients with melanoma. Four kinds of treatments are used:

• surgery (taking out the cancer in an operation)
  
• chemotherapy (using drugs to kill cancer cells)
  
• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
  
• biological therapy (using the body's immune system to fight cancer)

Surgery is the primary treatment of all stages of melanoma. The doctor may take out the melanoma using one of the following operations:

Conservative re-excision is an operation to take out any cancer that remains following biopsy, along with a small amount of skin around it (usually less than one-half of an inch).

Wide surgical excision takes out the cancer and some of the skin around the tumor.

Skin may have to be taken from another area of the body and put on the place where the cancer has been taken out. This is called grafting.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. If the melanoma occurs on an arm or leg, chemotherapy may be given with a technique called isolated arterial perfusion. In this method, chemotherapy drugs are put directly into the bloodstream of the arm or leg where the melanoma is found. This allows most of the drug to reach the tumor directly. However, chemotherapy alone has not been shown to be effective in treating melanoma. Clinical trials are being done to find chemotherapy drugs that are effective.

If a doctor removes all the cancer that can be seen at the time of the operation, a patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be found is called adjuvant chemotherapy. Adjuvant therapy has been shown to be effective for patients whose disease has spread to their lymph nodes. Clinical trials are being done to find adjuvant chemotherapy drugs that are effective.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy or immunotherapy. Clinical trials are being done to find biological therapies that are effective.

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