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Early-Stage Melanoma Treatment Options

Patient's Guide to Stage 0, I, and II Melanoma Treatment

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Updated August 12, 2013

Your doctor says that your biopsy came back positive for melanoma, the most aggressive form of skin cancer. Fortunately, it was caught as an early stage melanoma (0, I, or II), so your prognosis is good. But what's next? What are your treatment options? Here is an overview of what to expect. (A description of treatment options for more advanced stage III and IV melanoma is also available.)

Stage 0

Stage 0 ("in situ") melanomas have not spread beyond the epidermis (top layer of skin). They are usually treated with surgical removal ("excision") of the melanoma and a minimal amount (about 0.5 cm) of normal skin (called the "margin"). Surgery at this stage usually cures the disease. For melanomas on the face, some doctors may instead prescribe a cream containing the drug Aldara (imiquimod). This is mainly used when surgery would create a cosmetic problem. The cream is applied anywhere from once a day to two times a week for around three months.

Stage I

Treatment of stage I melanoma (that is, lesions 2 mm in thickness or less) consists of surgical removal of the melanoma and removal of 1 cm to 2 cm of normal skin surrounding it, depending on the thickness of the melanoma (called the "Breslow thickness"). Depending on the location of the melanoma, most patients can now have this procedure performed in an outpatient clinic or doctor's office.

Routine lymph node dissection (removal of lymph nodes near the cancer) has not been shown to improve survival in patients with stage I melanoma. Some doctors recommend sentinel lymph node mapping and biopsy if the melanoma is stage IB or has other characteristics that makes spread to the lymph nodes more likely.

Stage II

Wide excision is the standard treatment for stage II melanoma. If the melanoma is between 1 mm to 2 mm thick, a 1 cm to 2 cm margin of normal skin will be removed as well. If the tumor is 2 mm to 4 mm thick, at least 2 cm of normal skin will be removed from around the tumor site. If the tumor is more than 4 mm thick, a margin of 3 cm is recommended when anatomically possible.

Since the melanoma may have spread to lymph nodes near the tumor, some doctors may recommend a sentinel lymph node biopsy as well. If the sentinel node(s) is found, it will then be biopsied along with removing the melanoma. If the sentinel node contains cancer, then a lymph node dissection (where all the lymph nodes in that area are surgically removed) will be done at a later date.

In certain cases (such as if the tumor is found to be more than 4 mm thick or if lymph nodes contain cancer), some doctors may advise adjuvant therapy (additional treatment after surgery) with interferon-alfa2b. Other drugs or perhaps vaccines may also be recommended as part of a clinical trial to try to reduce the chance that the melanoma will come back. Current evidence for the effectiveness of adjuvant drug or radiation treatment for stage II patients, however, is limited.

A description of treatment options for more advanced stage III and IV melanoma is also available.

Sources:

"Treatment of Melanoma Skin Cancer by Stage." American Cancer Society. 16 December 2008.

"Melanoma Treatment PDQ." National Cancer Institute. 16 December 2008.

"Guidelines: Melanoma." National Comprehensive Cancer Network. 16 December 2008.

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