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Metastatic Melanoma Treatment Options

Patient's Guide to Stage III and IV Melanoma Treatment

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Updated October 01, 2009

Your doctor says that your biopsy indicates a diagnosis of advanced melanoma, the most aggressive form of skin cancer. What's next? What are your options? Here is an overview of what to expect so that you can ask informed questions about your treatment and your prognosis. (A description of melanoma treatment options for earlier stage 0, I and II disease is also available.):

Stage III

Surgical treatment for stage III melanoma involves excision (removal) of the primary tumor and usually the nearby lymph nodes as well. Adjuvant (after-surgery) therapy with interferon-alfa2b may help some patients with stage III melanoma fight off recurrence longer.

If the melanoma can't be completely removed, your doctor may inject a vaccine (BCG) or interleukin-2 directly into the tumors. For melanoma on an arm or leg, another possible option is to infuse the limb with a heated solution of the chemotherapy drug melphalan. In some cases, radiation therapy may be given after surgery in the area where the lymph nodes were removed, especially if many of the nodes were found to contain cancer. Other possible treatments include chemotherapy, immunotherapy or both combined (biochemotherapy).

Multiple new treatments being tested in clinical trials may benefit some patients. Many patients will not be cured with current treatments for stage III melanoma, so they may want to think about being in a clinical trial.

Stage IV

Stage IV melanoma is very hard to treat, since it has already metastasized (spread) to distant lymph nodes or other areas of the body. Surgical procedures will include removing the tumors, lymph nodes, or certain internal organs, depending on how many tumors are present, their location, and how likely they are to cause symptoms. Metastases that cause symptoms but cannot be removed surgically may be treated with radiation or chemotherapy.

The chemotherapy drugs in use at this time are of limited value in most people with stage IV melanoma. Dacarbazine (DTIC) and temozolomide (Temodar) are the ones most often used either by themselves or combined with other drugs. Even when chemotherapy shrinks these cancers, the effect is often only temporary, with an average time of 3 to 6 months before the cancer starts growing again. In rare cases, they can be effective for longer periods of time. Immunotherapy, using interferon-2b or interleukin-2, can help a small number of patients with stage IV melanoma live longer. Higher doses of these drugs seem to be more effective, but they also have more severe side effects.

Many doctors recommend biochemotherapy -- a combination of chemotherapy and either interleukin-2, interferon or both. For example, some doctors are combining interferon with temozolomide. The two drugs combined cause more tumor shrinkage, which may make patients feel better, although the combination has not been shown to help patients live longer. Another drug combination uses low doses of interferon, interleukin and temozolomide. Each seems to benefit some patients.

Since stage IV melanoma is difficult to treat with current therapies, you should discuss with your doctor if you are eligible for a clinical trial. Clinical trials of new chemotherapy drugs, new methods of immunotherapy or vaccine therapy and combinations of different types of treatments may benefit some patients. Even though the outlook for patients with stage IV melanoma tends to be poor overall, a small number of patients have responded extraordinarily well to treatment or have survived for many years after diagnosis.

A description of treatment options for early stages 0, I and II melanoma is also available.

Sources:

"Treatment of Melanoma Skin Cancer by Stage." American Cancer Society. 24 December 2008.

"Melanoma Treatment PDQ." National Cancer Institute. 24 December 2008.

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

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