Many people are frightened at the idea of having treatment for cancer, because of the side effects that can occur. Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss the treatment options in detail with your doctor or Skin Cancer Specialist Nurse.
Surgery
Surgery is the main treatment option for most cases of melanoma, and usually cures early stage melanomas. The surgery will leave a scar on the skin. However, if the surgery is not done the melanoma is likely to spread into the deeper layers of the skin and then to other areas of the body.
If you have been offered surgery to cure your melanoma, deciding whether to accept the treatment may not be difficult. However, if a cure is unlikely and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment.
When a diagnosis of melanoma is made by biopsy, the site will probably need to be excised again in order to reduce the risk of the melanoma coming back in the vicinity of your scar. Therefore, the tumour is cut out, along with a small amount of normal non-cancerous skin at the edges. The normal, healthy skin around the edges of the cancer is referred to as the margin. The size of the margin depends on the Breslow thickness of the tumour but varies from 1cm to 2cm. The sample will be viewed under a microscope to make sure that no cancer cells remain in the skin. When the original melanoma is thicker, the wider excision is done at the same time as the sentinel lymph node biopsy.
In many cases, after the wider excision has been done it is possible to close the wound by simply sticthing the edges together. However, in areas where the skin is tight, such as on the leg below the knee or on the scalp, it may not be possible to close the skin directly and your doctor may recommend that you have a skin graft or a repair with a flap. More complicated wounds, particularly in visible parts of your body such as your face, may require complicated reconstructive surgery under the care of your plastic surgeon.
Lymph Node Surgery:
If it has been detected that the melanoma has spread to the lymph nodes that drain the original melanoma (primary), your surgeon is likely to offer you a lymph node dissection in the area that is affected. You can get more information about these procedures by clicking on the links at the left-hand side of this page.
Chemotherapy
Chemotherapy uses drugs that kill cancer cells. Systemic chemotherapy uses drugs that are usually injected into a vein or given by mouth. These drugs travel through the bloodstream to all parts of the body and attack cancer cells that have already spread beyond the skin to lymph nodes and other organs.
Several types of systemic chemotherapy can be used to treat advanced melanoma. Although chemotherapy is usually not as effective in melanoma as in some other types of cancer, it may relieve symptoms or extend survival for some patients. Chemotherapy drugs for melanoma are being devleoped all the time and they often need testing to see whether they work in humans or whether they are more effective at treating melanoma than established drugs. Accordingly, you might be invited to take part in a research trial by your doctor.
Another form of chemotherapy is Isolated Limb Infusion.This is a type of chemotherapy sometimes used to treat advanced melanomas that are confined to an arm or leg. It is done during a surgical procedure. Instead of giving chemotherapy into a vein and letting it go throughout the body, this method temporarily separates the blood flow of the involved limb from the rest of the body and injects high doses of chemotherapy into the artery feeding the limb.
Possible side effects of chemotherapy
Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects may include:
* Hair loss
* Mouth sores
* Loss of appetite
* Nausea and vomiting
* Lowered resistance to infection (from low white blood cell counts)
* Easy bruising or bleeding (from low blood platelets)
* Fatigue (from low red blood cells)
There are often ways to lessen side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting.
Radiotherapy
Radiotherapy uses high-energy rays or particles to kill cancer cells. External beam radiation therapy focuses radiation from outside the body on the skin tumor. This type of radiation therapy is used for treating some patients with melanoma. The treatment is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time -- getting you into place for treatment -- usually takes longer.
Radiotherapy is not often used to treat the original melanoma that started on the skin. In some cases, it may be given as an adjuvant to surgery in the area where lymph nodes were removed, especially if many of the nodes contained cancer cells. This is to try to reduce the chance that the cancer will come back.
Radiotherapy may also be used to treat melanoma that has come back (recurred), either in the skin or lymph nodes, after surgery, or to treat distant spread of the disease.
Radiotherapy is often used to relieve symptoms caused by metastases to the brain or bone (palliative therapy). Palliative radiation therapy is not expected to cure the cancer, but it may help shrink it for a time to control some of the symptoms.
Follow-Up
Once your treatment ends you will need regular check-ups.
Although most people with thin melanomas are cured by simply having the mole removed, a few people later develop another melanoma. It is important, therefore, to have regular check-ups and to know what to look for.
It is possible for the melanoma to come back in the same area, so if you notice any change or lumps in the area on the scar or nearby it is essential to see your doctor. If you notice any new symptoms or are worried in between appointments you can always contact your specialist nurse at the hospital. You can also arrange to have an earlier appointment by contacting your doctor’s secretary.
At your regular check-ups your doctor will check the lymph nodes close to the area where the melanoma was removed.
We are currently running a trial, called the Mel-FO study, at the Norfolk & Norwich Skin Tumour Unit looking into how frequently certain melanoma patients need following up.