Melanoma Treatment (PDQ�)
General Information About Melanoma
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).
The skin is the body?s largest
When
There are 3 types of skin
Melanoma.
Basal cell skin cancer .Squamous cell skin cancer .
Melanoma is more
Melanoma can occur anywhere on the body.
In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs. Melanoma usually occurs in adults, but it is sometimes found in children and adolescents.
Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.
Anything that increases your risk of getting a disease is called a
Having a fair complexion, which includes the following:
Fair skin that freckles and burns easily, does not tan, or tans poorly.
Blue or green or other light-colored eyes.
Red or blond hair.
Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
Having a history of many blistering sunburns as a child.
Having several large or many small
moles .Having a
family history of unusual moles (atypicalnevus syndrome ).Having a family or
personal history of melanoma.Being white and male.
Possible signs of melanoma include a change in the appearance of a mole or pigmented area.
These and other
A mole that:
changes in size, shape, or color.
has irregular edges or borders.
is more than 1 color.
is
asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).itches.
oozes, bleeds, or is
ulcerated (a hole forms in the skin when the top layer ofcells breaks down and thetissue below shows through).
Change in pigmented (colored) skin.
Satellite moles (new moles that grow near an existing mole).
Tests that examine the skin are used to detect (find) and diagnose melanoma.
If a mole or pigmented area of the skin changes or looks
Skin examination: A doctor or
nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.Biopsy : Alocal excision is done to remove as much of the suspicious mole orlesion as possible. Apathologist then looks at the tissue under amicroscope to check for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.
Suspicious areas of the skin should be biopsied and not be shaved off or
Certain factors affect prognosis (chance of recovery) and treatment options.
The
The thickness of the
tumor and where it is in the body.How quickly the cancer cells are dividing.
Whether there was bleeding or ulceration at the
primary site.Whether cancer has spread to the
lymph nodes or to other places in the body.The number of places cancer has spread to in the body and the level of
lactate dehydrogenate (LDH) in theblood .The patient?s general health.
Although many people are successfully treated, melanoma can
Stages of Melanoma
After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
The process used to find out whether
The following tests and procedures may be used in the staging process:
Wide local excision : Asurgical procedure to remove some of the normaltissue surrounding the area wheremelanoma was found, to check for cancercells .Lymph node mapping andsentinel lymph node biopsy : Procedures in which aradioactive substance and/or bluedye isinjected near thetumor . The substance or dye flows throughlymph ducts to thesentinel node or nodes (the firstlymph node or nodes where cancer cells are likely to have spread). Thesurgeon removes only the nodes with the radioactive substance or dye. Apathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes.Chest x-ray : Anx-ray of theorgans and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into avein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the chest,abdomen , andpelvis .MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).PET scan (positron emission tomography scan): A procedure to findmalignant tumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into avein . The PETscanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.Laboratory tests : Medical procedures that test samples of tissue,blood ,urine , or other substances in the body. These tests help todiagnose disease, plan and check treatment, ormonitor the disease over time.Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for anenzyme calledlactate dehydrogenase (LDH).
The results of these tests are viewed together with the results of the tumor
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
Through
tissue . Cancerinvades the surrounding normal tissue.Through the
lymph system . Cancer invades the lymph system and travels through thelymph vessels to other places in the body.Through the
blood . Cancer invades theveins andcapillaries and travels through the blood to other places in the body.
When cancer
The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
The staging system is based on the following:
The thickness of the tumor. The thickness is described using the
Breslow scale .Whether the tumor is
ulcerated (has broken the skin).Whether the tumor has spread to the lymph nodes and if the lymph nodes are joined together (matted).
Whether the tumor has spread to other parts of the body.
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
In
Stage I
In
Stage IA: In stage IA, the
tumor is not more than 1millimeter thick, with noulceration .Stage IB: In stage IB, the
tumor is either:not more than 1
millimeter thick and it hasulceration ; ormore than 1 but not more than 2 millimeters thick, with no ulceration.
Stage II
Stage IIA : In stage IIA, thetumor is either:more than 1 but not more than 2
millimeters thick, withulceration ; ormore than 2 but not more than 4 millimeters thick, with no ulceration.
Stage IIB : In stage IIB, thetumor is either:more than 2 but not more than 4
millimeters thick, withulceration ; ormore than 4 millimeters thick, with no ulceration.
Stage IIC : In stage IIC, thetumor is more than 4millimeters thick, withulceration .
Stage III
In
Cancer has spread to one or morelymph nodes .Lymph nodes may be joined together (matted).
Cancer may be in a
lymph vessel between theprimary tumor and nearby lymph nodes.Very small tumors may be found on or under the skin, not more than 2
centimeters away from where the cancer first started.
Stage IV
In
Recurrent Melanoma
Treatment Option Overview
There are different types of treatment for patients with melanoma.
Different types of treatment are available for patients with
Four types of standard treatment are used:
Surgery
Local excision : Taking out the melanoma and some of the normaltissue around it.Wide local excision with or without removal oflymph nodes .Lymphadenectomy : A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.Sentinel lymph node biopsy : The removal of thesentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. Aradioactive substance and/or bluedye isinjected near the tumor. The substance or dye flows through thelymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed forbiopsy . Apathologist views the tissue under amicroscope to look for cancercells . If cancer cells are not found, it may not be necessary to remove more lymph nodes.
Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered
Chemotherapy
Chemotherapy is a cancer treatment that uses
In treating melanoma, anticancer drugs may be given as a
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Melanoma for more information.
Radiation therapy
Biologic therapy
See Drugs Approved for Melanoma for more information.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site
Chemoimmunotherapy
Targeted therapy
Monoclonal antibody therapy is a cancer treatment that uses
Vaccine therapy
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed.
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options by Stage
A link to a list of current
Stage 0 (Melanoma in Situ)
Treatment of
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage I Melanoma
Treatment of
Surgery to remove thetumor and some of the normaltissue around it.A
clinical trial of surgery to remove the tumor and some of the normal tissue around it, with or withoutlymph node mapping andlymphadenectomy .A clinical trial of new techniques to detect
cancer cells in thelymph nodes .A clinical trial of lymphadenectomy with or without
adjuvant therapy .
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Melanoma
Treatment of
Surgery to remove thetumor and some of the normaltissue around it, followed by removal of nearbylymph nodes .Lymph node mapping andsentinel lymph node biopsy , followed by surgery to remove the tumor and some of the normal tissue around it. Ifcancer is found in thesentinel lymph node , a second surgery may be done to remove more nearby lymph nodes.Surgery followed by high-
dose biologic therapy .A clinical trial of
adjuvant chemotherapy and/orbiologic therapy .A clinical trial of new techniques to detect cancer
cells in the lymph nodes.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Melanoma
Treatment of
Surgery to remove thetumor and some of the normaltissue around it.Surgery to remove the tumor with
skin grafting to cover thewound caused by surgery.Surgery followed by
biologic therapy .A
clinical trial of surgery followed bychemotherapy and/or biologic therapy.A clinical trial of biologic therapy.
A clinical trial comparing surgery alone to surgery with biologic therapy.
A clinical trial of
chemoimmunotherapy or biologic therapy.A clinical trial of
hyperthermic isolated limb perfusion using chemotherapy and biologic therapy.A clinical trial of biologic therapy and
radiation therapy .
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Melanoma
Treatment of
Surgery orradiation therapy aspalliative therapy to relievesymptoms and improvequality of life .Chemotherapy and/orbiologic therapy .A
clinical trial of new chemotherapy, biologic therapy, and/ortargeted therapy withmonoclonal antibodies , orvaccine therapy.A clinical trial of radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of surgery to remove all known cancer.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV melanoma and recurrent melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment Options for Recurrent Melanoma
Treatment of
Surgery to remove thetumor .Hyperthermic isolated limb perfusion .Radiation therapy aspalliative therapy to relievesymptoms and improvequality of life .Palliative treatment with
biologic therapy .A
clinical trial of biologic therapy and/orchemotherapy as palliative therapy to relieve symptoms and improve quality of life.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Melanoma
For more information from the
Melanoma Home Page
What You Need to Know About? Melanoma and Other Skin Cancers
Common Moles, Dysplastic Nevi, and Risk of Melanoma
Skin Cancer Prevention Skin Cancer Screening Sentinel Lymph Node Biopsy
Drugs Approved for Melanoma
Biological Therapies for Cancer: Questions and Answers
Understanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies)
Targeted Cancer Therapies
For general
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Cancer Staging
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Cancer Library
Information For Survivors/Caregivers/Advocates
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About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
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The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
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PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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