Melanoma Treatment Options

SURGERY
Treatment consists of urgent local or wide local excision, with a 2cm margin. The amount of normal skin removed from around the tumour is between 5mm to 2cm. The wound is stitched and heals as a straight scar. Histological analysis will determine the depth of invasion using Clark’s level and thickness of the tumour using Breslow thickness.

- If the melanoma is at an early enough stage, the removal will be enough and no further treatment is necessary, although follow ups are necessary to make sure it has not spread.
- For a larger tumour, a larger amount of skin is cut out to make sure as many cancer cells as possible are removed. This usually requires general anaesthetic, and potentially a brief stay in hospital.

If the wound is large enough, a skin graft may be put over it. Alternatively, a ‘flap’ which is a section of nearby skin which is still attached can be placed over the wound. Regardless, the wound is dressed and left undisturbed for several days. After the removal, the patient may be in pain and require painkillers. Risks include infection, haemotoma (bruising) and scarring, or the skin graft failing. Recovery time varies although most people are back to normal after two weeks.

TESTING
Sentinel node biopsy or fine needle aspiration of lymph nodes is necessary for patients with thicker lesions for predicting prognosis. Sentinel node biopsy involves injection of a harmless dye or radioactive chemical into where the melanoma developed. The sentinel nodes drained the fluid from around the site. After about an hour, a ‘counter’ is passed over the area and the sentinel nodes are identified and then removed and checked for cancer. Fine needle aspiration draws fluid from a lymph node and examined. If cancer cells are found, the lymph nodes may be surgically removed. Metastatic disease treatment can involve surgery to lymph nodes, radiotherapy, immunotherapy and chemotherapy.

RADIOTHERAPY
Radiotherapy uses radiation to kill or injure cancer cells. It can be used to eliminate, control or relieve symptoms. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. It precisely targets cancer sites, which means as little harm to normal tissues as possible. Side effects of melanoma radiotherapy may involve reddening or burning of the skin. Others may occur depending on where the treatment is.

CHEMOTHERAPY
Chemotherapy is not often able to cure melanoma and may sometimes be used as palliative care (pain relieving). Chemotherapy given after surgery to kill remaining cancer cells to increase the chance of a cure is called adjuvant therapy. In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion, which is a regional treatment as opposed to a systemic treatment. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred.
Alternatively, normal chemotherapy can be given. The cytotoxic drugs cannot distinguish between cancer and other fast-growing cells healthy cells eg. hair and blood cells, which are also eliminated, causing side effects. Though, these cells usually repair themselves after chemotherapy.

Side effects: some may cause dose reductions, treatment delays or be life-threatening: Feeling sick, nausea, vomiting, depression, fatigue, thinning or loss of hair, low white and red blood cell count, low platelet count. Neutropenia: low count of infection-fighting white blood cells causing severe immunosuppression.

Course usually 6-12 months, drugs injected into a body cavity, intravenously, or delivered orally as a pill, depending on which drug is used.

BIOLOGIC THERAPY
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Types include: interferon, interleukin, monoclonal antibodies, colony-stimulating factors, cytokines and vaccines.


New types of treatment are being tested in clinical trials. These include the following:

CHEMOIMMUNOTHERAPY
Chemoimmunotherapy is the use of anticancer drugs combined with biologic therapy to boost the immune system to kill cancer cells.

COMPLEMETARY AND ALTERNATIVE THERAPIES
The following therapies have been shown to be helpful in dealing with the side effects of cancer treatment in some clinical trials:

psychotherapy, counselling, relaxation, support groups: help reduce stress
meditation: improves sleep and reduces stress
yoga: improves sleep and reduces stress
massage: helps reduce pain and fatigue, and improves sleep
tai chi: relieves pain, improves flexibility and strength, and reduces stress
reflexology: reduces anxiety
spiritual practices: help reduce stress
acupuncture: reduces nausea, vomiting and fatigue from chemotherapy and radiotherapy
aromatherapy: improves sleep
art and music therapy: provide distraction from pain and aid relaxation.

http://www.cancervic.org.au
http://www.cancercouncil.com.au/