Treatments for Advanced Melanoma

By

Christopher Iliades, MD

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Having advanced melanoma means your cancer has spread from where it started originally. How far it has spread will affect how your doctor will treat it.

Melanoma can spread to your lymph nodes or travel through your bloodstream to other parts of your body. The stage of your cancer will tell you this. Stage IIIC and IV melanomas are advanced:

  • Stage IIIC means the cancer has spread away from the original tumor to at least one lymph node, to nearby skin or to lymph channels. The lymphatic system is a network of channels and nodes that help your body fight infections.

  • Stage IV melanoma is when the cancer has spread to a distant part of your body like your lungs or brain. It spreads by traveling through your bloodstream or lymphatic system.

Treatment for advanced melanoma needs to include more than just surgery. You also may need to have X-ray treatment, take drugs like chemo that kill cancer cells, take drugs that stimulate your immune system, or take drugs that target specific cancer cells.

Surgery

For stage III advanced melanoma, your doctor may operate to remove lymph nodes as well as the melanoma. During the surgery, the doctor will also remove some normal tissue around the melanoma to make sure no cancer cells remain.

With stage IV melanoma, you may be a candidate for surgery to relieve pain or other symptoms from cancer that has spread. The goal of surgery is to keep you more comfortable and improve your quality of life. It also may help you live longer.

Radiation

Radiation therapy kills cancer cells with X-rays. Doctors may use radiation for stage III melanoma after surgery to remove lymph nodes. The goal is to keep the cancer from coming back. For stage IV melanoma, radiation may be used to relieve symptoms in a part of the body that the cancer has spread to. If it's spread to the brain, for instance, the goal of radiation is to shrink the tumor and ease the symptoms it's causing.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is not the first treatment for advanced melanoma because chemotherapy drugs do not work as well for melanoma as they do for other types of cancer. If you do have chemo, you might get the drugs intravenously (IV) or take them as pills. Sometimes doctors prescribe chemotherapy alone. In other cases, doctors find that combining chemo drugs with drugs that boost the immune system works better than chemo alone.

Immunotherapy

Immunotherapy for advanced melanoma boosts the immune system. Immunotherapy uses specific proteins to make your body's own defense system kill cancer cells.

One type of immunotherapy is ipilimumab. It's not a "drug" in the usual sense, but a man-made immune system protein. It helps your body release more T cells, which are white blood cells that fight disease. Ipilimumab cannot cure advanced melanoma. But, it can help you live longer. You take this drug by IV.

Cytokines are another type of immunotherapy that boosts the immune system. Treatment for advanced melanoma uses two man-made cytokines: interferon and interleukin-2. They shrink melanoma tumors. Sometimes doctors combine them with chemotherapy.

Getting a particular vaccine is another way to stimulate the immune system. For this approach, a doctor injects the BCG vaccine directly into an advanced melanoma tumor. BCG stands for Bacille Calmette-Guerin. Your doctor injects enough of the vaccine to act like a cytokine and stimulate your immune system.

Targeted Therapy

In about half of all melanoma tumors, mutated genes trigger their growth. Your doctor can do a special test to tell if an abnormal gene is stimulating your melanoma. If that's the case, you may be able to get targeted therapy for advanced melanoma.

So far, the U.S. Food and Drug Administration (FDA) has approved three drugs that target advanced melanoma: vemurafenib, dabrafenib and trametinib. They block the abnormal genes that are making your tumor grow. These drugs come as pills or capsules. Some studies suggest that combinations of these drugs may work better than using just one of them. But, these are new drugs, and doctors are still learning about them.


One way to benefit from these or other new drugs that become available is to take part in a clinical trial. Ask your doctor if there is a clinical trial that could help you.

Key Takeaways

  • You need more than surgery to treat advanced melanoma.

  • The stage of your melanoma and the presence of mutated genes will determine what treatments will work best.

  • Additional treatment options include radiation, chemotherapy, immunotherapy, and targeted therapy.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 22, 2016

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Medical References

  1. Two New Drugs Increase Survival for Patients With Advanced or Metastatic Melanoma. American Society of Clinical Oncology. http://www.cancer.net/research-and-advocacy/research-summaries/two-new-drugs-increase-survival-patie...
  2. How is melanoma skin cancer staged? American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging
  3. Treatment of melanoma skin cancer by stage. American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-by-stag...
  4. Chemotherapy for melanoma skin cancer. American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-chemoth...
  5. Immunotherapy for melanoma skin cancer. American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-immunot...
  6. Radiation therapy for melanoma skin cancer. American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-radiati...
  7. Surgery for melanoma skin cancer. American Cancer Society. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-surgery
  8. Targeted therapy for melanoma skin cancer. American Cancer Society.http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-targete...
  9. Lymph Node Involvement. Skin Cancer Foundation. http://www.skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma/lymph-node-involve...

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