Surgery

Primary melanoma is always removed by surgery, with enough normal skin from around the melanoma to make sure all the cancer cells have been removed (this is referred to as the safety margin). The margin removed depends on the thickness of the melanoma, anywhere between 5mm and 3cm.

Localised metastatic melanoma is best treated by surgical excision as well. Metastatic disease that spreads to distant skin sites and lymph nodesis usually able to be treated in this manner, and even spread to internal organs can sometimes be removed successfully with surgical intervention.

Sentinel Node Biopsy

A new technique to see if the melanoma has spread to the lymph nodes closest to the melanoma is called “sentinel node biopsy”. A substance containing a small amount of radioactivity is injected into the skin around the tumour. The substance passes into the lymph fluid and is trapped by the sentinel node. That lymph node can be removed and examined to see if there are any cancer cells in it. This technique is only used for thicker melanomas.

Examination of the “sentinel” lymph node or nodes in a patient with a primary melanoma on the skin very accurately indicates whether it has spread to the regional lymph nodes (e.g. in the groin, the armpit or the neck) has occurred. This means that patients who are at the highest risk of later developing melanoma-related problems are identified at an early stage of the disease. What is not yet clear is whether this earlier identification makes any difference to the ultimate outcome, and this is one of the important things that will be clarified by the results of the Multi-Center Selective Lymphadenectomy Trial*. It is also clear at this stage that the likelihood of a sentinel lymph node containing metastatic (secondary) melanoma cells is closely related to primary tumour thickness (routinely measured in millimetres by the pathologist).

The Sydney Melanoma Unit’s experience is that if the primary tumour is less that 1.5mm in thickness, the risk of the tumour having spread to the lymph nodes is 5%, if the primary tumour is between 1.5mm and 3mm the risk is 14%, and if the primary tumour is more than 3mm in thickness, the risk is 24%.

Chemotherapy

At this stage Interferon is used as a form of chemotherapy in the treatment in melanoma when there is no known disease present. It takes the form of a month course of Intravenous administration followed by a course of adjunctive therapy. The side effects of this can be quite severe and constant consultation with your oncologist is needed during treatment.

Does Interferon prevent melanoma recurrence?
The interferons are a family of proteins produced by the body’s immune system. They serve a variety of purposes, including helping to defend against viruses, like influenza. There is good laboratory evidence, and some clinical evidence, that they also work to kill melanoma cells, both directly and also by stimulating the immune system to attack the cancer cells. The main interferon that works against melanoma is called interferon-alpha.

For over 10 years a vigorous debate has taken place between melanoma specialists as to whether or not interferon protects people from recurrence of melanoma, once they have had a melanoma removed.

Throughout the 1980’s and '90’s a series of clinical trials was performed in the USA and Europe to investigate the use of interferon-alpha in reducing the risk of recurrence after high-risk melanoma had been removed. Unfortunately, the results of those trials were very confusing due to different groups of patients tested, different dosage schedules chosen, and other factors.

There is now fairly good evidence that low dose and intermediate dose interferon have little effect, but a serious question mark remains over the use of high-dose interferon, or “HDI”. Three trials suggest that HDI significantly prolongs the time between the initial melanoma and any relapse that may occur. However, HDI involves giving the drug via a drip into the vein daily for a month as an outpatient. The side-effects of this treatment are considerable, and may include fevers, fatigue, muscle pains and mood disturbance. Many of these side-effects can be controlled and modified, but patients receiving the treatment require careful monitoring and special nursing care

There are other forms of chemotherapy being used in a trial stage for malignant melanoma where there is metastases present that can be monitored and measured in response to the treatment. Your oncologist will be able to discuss the relevant options that are applicable to you and your journey.

Radiotherapy

This form of treatment uses x-rays to kill cancer cells by targeting the cancer sites within the body. Treatment is carefully planned to do little harm as possible to the bodies normal tissue.Radiotherapy may be used when metastatic melanoma has spread to an internal organ or as a preventative after excision of melanoma.

Radiotherapy can cause temporary side effects including tiredness, nausea, irritation of the skin and hair loss.

Immunotherapy Vaccine