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Melanoma Treatment Options

Surgery

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 Therapy

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

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

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.

Immunotherapy

Immunotherapy 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.

Side Effects of Treatment

Everyone reacts differently to treatment and experiences side effects differently. It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.

The side effects can also vary depending on the type of therapy or treatment that you receive. Targeted therapy and immunotherapy, which uses your own immune system to target and kill the cancer cells, may cause flu-like symptoms, chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting and diarrhea. People may also experience a skin rash.

Radiation therapy may cause a person to experience red or dry skin and hair loss. Radiation therapy also may cause fatigue.

Chemotherapy has different side effects depending on the type and dose of drugs given and the length of time they are taken. These side effects can include hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased chance of infections (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelet counts) and fatigue (due to low red blood cell counts).