Skin Cancer: Malignant Melanoma Treatment

  • Treatment

    Maintaining a positive attitude is particularly challenging when facing a serious illness. The mental aspects of a major illness should never be discounted, and patients must be offered the emotional support they need. The first step is feeling confident that one is getting the best possible treatment. Don't hesitate to discuss concerns and options as often as necessary with health providers.

    Family and friends are often glad to help with various tasks, or merely being a sounding board for feelings. Support groups, often organized by hospitals and medical centers, can be an invaluable source of comfort.

    Specific methods to help relieve stress and enhance mood, such as yoga, positive visualization, and humor, should also be pursued. Many stress-relief techniques are taught on tape or videos. A doctor-approved program of regular exercise is also important for both mental and physical well-being.

    Try to maintain the activities that you enjoy, being careful to avoid excess sun exposure. As much as possible, stay involved in life by looking forward to activities in the future, including weekend and holiday plans, work goals, and family and social occasions.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Radiation and therapy that either boosts the immune system or attacks cancer cells directly (immunotherapy) are used for advanced disease, but so far no treatment has proven highly successful. Radiation therapy is often used to treat cancer that has spread to the brain or to bone. High energy x-rays are directed to the affected sites to kill the cancer cells and slow their rate of growth. The treatment is not regarded as curative, but may relieve symptoms.

    There is great interest in immunotherapy (also called biological therapy) in the treatment of advanced disease. This includes experimental melanoma vaccines that enhance the body's immune system. For this procedure, tumor cells are removed from the patient and grown in a laboratory. Genetic material is introduced into the cells to make them more readily identifiable to the body's immune system. They are then returned to the patient's body in the hopes that the immune system will respond by killing cancer cells.

    Other types of immunotherapy make use of various natural, disease-fighting substances. Interferon-alpha (Intron A) is based on a substance normally produced by cells in the blood and lymphatic system (lymphocytes) after contact with viruses or tumor cells. In addition to its cancer-fighting properties, it helps prevent the formation of new blood vessels that grow to nourish the tumor. It has been shown in studies to improve survival for stage III patients, and is an FDA-approved therapy. Common side effects are flu-like symptoms such as fever, chills, aches, and fatigue. Other substances that work by similar principles are under investigation, including tumor-necrosis factor, lymphokines, and interleukin-2.

    Melanoma is initially treated by surgical removal of the primary lesion. The melanoma lesion is removed surgically. Newer techniques enable doctors to take off less of the surrounding tissue, thus creating a smaller scar. Smaller melanomas can usually be removed in a doctor's office as an outpatient procedure under local anesthesia. The wound typically heals in one to two weeks. This can be curative for small cancers.

    In addition, the doctor may remove nearby lymph nodes to find out whether cancer has spread, and to determine how to proceed with further treatment.

    Some alternative medicines are used in the treatment of melanoma and other cancers.

    Cow and shark cartilage. Agents that block the formation of new blood vessels that supply blood to tumors have been found in cow and shark cartilage. However, three studies of humans had inconclusive results about whether cartilage is effective as a treatment for cancer. More clinical trials of cow and shark cartilage are currently underway.

    Coenzyme Q10. Coenzyme Q10 is sold as a dietary supplement, and there have been anecdotal reports of this enzyme lengthening the lives of cancer patients. However, there has been no report of a randomized clinical trial of this agent published in a peer-reviewed medical journal.

    Mistletoe. In laboratory studies, extracts of mistletoe have both killed cancer cells and boosted the immune system. However, clinical trials in humans have not shown that mistletoe is an effective treatment for cancer. It is not sold commercially in the U.S.

    Pregnant women with localized melanoma have the same prognosis as nonpregnant patients; there is no benefit in terminating the pregnancy. However, if the melanoma has spread to the lymph nodes, pregnant women have worse outcomes than other patients with the same stage disease. These women should discuss the risks of future pregnancies with their doctors, as should women whose lesions began to change during pregnancy.

    Malignant melanoma is regarded as one of the deadliest cancers. However, cure rates are high if lesions are removed at an early stage. The best predictive factor of melanoma is how thick the tumor is at the time of removal. If still thin and localized, the chance of cure is very good.

    For cancers that have not been caught in the earliest stage, long disease-free periods are common. Unlike most other cancers, in which 5-year survival is a good indicator of cure, 13% of recurrences of melanoma take place between 5 and 10 years after the cancer has been treated.

    Regular follow-up is essential, even after apparently successful treatment. Regular complete checkups are important for the rest of the patient's life, including a thorough skin exam, palpation of lymph nodes, and an annual chest x-ray for patients with tumors greater than 1 mm thick. Self-examination should be done once a month, and a complete skin examination at least once a year. Depending on the tumor stage, more frequent examinations may be necessary.

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I'm Kristen Dore, PharmD. Welcome to PDR Health!

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