If you have been diagnosed, talk through all of your options with your doctor and develop a treatment plan that best fits your needs
. Some important questions to ask your doctor as you consider your options:
- What is the type and stage of my melanoma?
- What treatment do you recommend and why?
- Am I eligible for a clinical trial?
- How often will I receive treatment and for how long?
- What is the plan if my disease progresses?
- How often will I need to come in for follow-up care?
- How will treatment affect my quality of life?
- What side effects of treatment should I expect?
- What other resources are available to learn more about my disease and treatment options?
You have the right to a second, and even third, opinion at any point in your cancer experience. A second opinion can help you confirm your diagnosis, understand your treatment options, provide you with access to clinical trials, and help you determine which health care team you would like to work with.
There are several treatment options for melanoma, depending on the extent of the disease and the person’s age and general health. Below is an overview of potential treatment options for melanoma.
Surgery is the most common treatment for melanoma that has not spread to different organs. A surgeon removes the tumor and some normal tissue surrounding it to reduce the chance that cancer cells will remain in the area and grow again.
The amount of surrounding skin removed depends on the thickness of the melanoma and how invasive it is. If a large area of tissue is removed, the surgeon may do a skin graft. In this case, skin from another part of the body is used to replace the skin that was removed.
Lymph nodes near the tumor may also be removed because cancer can spread through the lymphatic system. Surgery is usually not effective in controlling melanoma that has spread to other parts of the body (known as metastatic melanoma). In these cases, doctors may use other methods of treatment.
Radiation is not commonly used to treat the primary melanoma, but may be used to treat areas where lymph nodes have been removed to lower the risk that the cancer will return. Radiation therapy may also be used to help alleviate symptoms by temporarily shrinking tumors if the melanoma that has spread to the brain, bones, and other parts of the body.
Chemotherapy is the use of drugs to destroy cancer cells. Since chemotherapy attacks cells that are quickly dividing, the drugs kill both healthy cells and cancer cells. Chemotherapy is commonly used when the melanoma has spread. Chemotherapy drugs are sometimes given alone but many are combined with other drugs, which can increase the number of side effects a person experiences.
Targeted therapy uses drugs to target specific genes, proteins or pathways related to a cancer’s growth and survival. These drugs work by stopping the cancer’s growth by stopping the blood supply to the tumor or by blocking a signal that is sent to the cancer to keep it growing. Researchers are still learning about the best way to use targeted drugs. They have learned that half of all melanomas have a mutation in the BRAF gene. Two targeted drugs have been approved by the U.S. Food and Drug Administration (FDA) to target this mutation and are known as BRAF inhibitors. They include: vemurafenib (Zelboraf®) and dabrafenib (Tafinlar®). Another targeted drug blocks proteins found in melanoma known as MEK. The FDA approved the use of trametinib (Mekinist™), which is a MEK inhibitor, to treat advanced melanoma. Trametinib is often given in combination with dabrafenib because studies have shown that they appear to work better together.
uses a person’s own immune system to recognize and attack cancer cells. The FDA recently approved three drugs for advanced melanoma that are monoclonal antibodies, which are antibodies created in the lab, to target and block specific proteins in the body that normally work to suppress the immune system. These drugs are ipilimumab (Yervoy®) and most recently pembrolizumab (Keytruda®) and nivolumab (Opdivo®). Researchers have also created proteins to boost a person’s immune system. The FDA approved a drug called aldesleukin (Proleukin®) to enhance the body’s T-cells to recognize and destroy cancer cells.
For more information on immunotherapy advances in melanoma, check out CSC’s Frankly Speaking About Cancer: Immunotherapy & Melanoma Treatment fact sheet
Talk to Your Doctor About Clinical Trials
are testing new ways to use or combine drugs or techniques that are already approved or study novel therapies. You or your doctor may be interested in pursuing a clinical trial to help manage your melanoma. Clinical trials offer patients the opportunity to benefit from new combinations of therapies while also advancing the pace of knowledge about the disease and treatment options.
If your doctor has not mentioned a clinical trial as an option, ask if it is right for you. Although there is much information about clinical trials on the internet, it is important to talk with your doctor so you can find the right trial for you. Each trial has specific guidelines and eligibility criteria, including age, exclusions based on prior treatments and stage of your disease. Your doctor or nurse will also be able to explain to you what participating in a clinical will entail and how it may affect your care and daily life.
Updated March 23, 2015