Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.
Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want.
Treatments for melanoma include surgery, radiotherapy and chemotherapy. Some new treatments are tested in clinical trials. You may have one of these treatments or a combination. For most people who develop melanoma, surgery is all that is required.
Making decisions about treatment
Sometimes it is hard to decide which is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. Waiting for test results and for treatment to begin can be very difficult. While some people feel they have too much information, others may feel that they do not have enough.
You need to make sure that you know enough about your illness, the possible treatment and side effects to make your own decisions. If you are offered a choice of treatments, you will need to weigh up the good and bad points about each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised. Some people with advanced cancer will always choose treatment, even if it only offers a small chance of cure. Others want to make sure that the benefits of treatment outweigh any side effects. Still others will choose the treatment they think offers them the best quality of life. Some may choose not to have treatment except to have any symptoms managed to maintain the best possible quality of life.
Talk to your doctor
You may want to see your doctor a few times before making a final decision on treatment. It is often hard to take everything in, and you may need to ask the same questions more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.
Talk to others
Once you have talked about treatment options with your doctor, you may want to talk them over with family or friends, with nursing staff, the hospital social worker or chaplain, or your own religious or spiritual adviser.
Talking it over can help to sort out which course of action is right for you. You may be interested in looking for information about melanoma on the Internet. While there are some very good websites, you need to be aware that some websites provide wrong or biased information.
Melanomas are always removed surgically. The tumour is cut out and when the diagnosis of melanoma has been confirmed, another procedure is undertaken to remove an appropriate safety margin of normal-looking skin from around the melanoma. All melanomas need to be removed with a safety margin of normal skin. People with a melanoma which has grown deeper into the skin need a larger amount of skin to be cut out. This may be done under a local or a general anesthetic. It is generally done as a second procedure after the initial removal. This margin will vary from 5 millimeters to 2 centimeters according to the depth of the melanoma. The purpose is to remove any persisting melanoma in the surrounding skin and to prevent the melanoma growing back at the same site.
Sometimes a skin graft is required to cover the wound. For the graft, the surgeon will take a layer of skin from another part of your body and place it over the wound. The other possibility is to do a ‘flap’, where the surgeon will close the wound using a nearby flap of skin. Most people however will be able to have the skin sewn up without a graft or flap.
After the operation
The wound will be covered with a dressing and left undisturbed for several days. It will then be checked to see if it is healing properly. If you had a skin graft, you will also have dressings on any area from which the skin was taken.
You may be uncomfortable for some days after your operation. If you have pain, tell your doctor or nurse. If you have a skin graft, the area where the skin is grafted on may be discoloured for months after the operation, but eventually the redness will fade. There is a risk of infection, haematoma and scarring following surgery for melanoma. Occasionally, the skin graft fails to take. If this happens to you, your doctor will explain what further treatment you will need.
Lymph node biopsy and dissection
If there is suspicion that the melanoma might have spread to your lymph nodes, your doctor may recommend that you have a fine needle aspiration biopsy or sentinel lymph node biopsy (see above). In a fine needle aspiration biopsy, the doctor inserts a needle into the node suspected of being affected by cancer and draws tissue into the syringe. Sometimes this is done in conjunction with an ultrasound assessment of the lymph node. This tissue is then examined under a microscope to see if it contains cancer cells. Occasionally, a node is removed surgically (‘open biopsy’) so that the tissue can be examined. If cancer cells are found in the node/s, other nodes in the region may be surgically removed (‘dissected’) to eradicate melanoma in adjacent lymph nodes.
Immunotherapy is the use of drugs which stimulate the body to fight infection. It is being researched as a possible future treatment in melanoma to stimulate the body’s normal cells to attack cancer cells. Clinical trials are testing the possible effectiveness of immunotherapy in treating melanoma. Your medical oncologist will be able to discuss these trials with you.
Radiotherapy treats cancer by using radiation to kill or injure cancer cells. The radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue. You will probably have radiotherapy once a day from Monday to Friday, with a break at the weekend, over several weeks. The number of visits you need to make will depend on the size and type of the cancer and on your general health.
The treatment itself only takes a few minutes, although you may need to wait before each treatment. Radiotherapy does not make you radioactive, so it is quite safe to be close to your partner, children and others during the course of treatment.
Side effects of radiotherapy depend on the part of the body being treated. Radiotherapy for melanoma usually involves treatment to the skin and nearby lymph nodes. Side effects may include reddening of the skin. Others may occur, depending on where your treatment is. Talk with your doctor or the radiotherapy staff about any possible side effects and how to manage them.
Chemotherapy is the treatment of cancer with anti-cancer drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves. In melanoma, chemotherapy is used as palliative treatment to try to control the growth of the cancer. Chemotherapy usually does not cure melanoma.
Chemotherapy is usually given by injecting the drugs into a vein (intravenous treatment). There are other types of chemotherapy, including tablets, which may be suitable for you. Some drugs used in chemotherapy can cause side effects. They may include feeling sick (nausea), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. Generally, these side effects are temporary and can be prevented or reduced. These days, new treatments are available that can help to make many side effects of chemotherapy much less severe than they were several years ago.
When cancer can’t be cured
If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment.
In this case, treatment may help relieve any symptoms, can make you feel better and may allow you to live longer.
Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this. General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer. For further information, contact the Cancer Helpline or Palliative Care Victoria.
Melanoma is most likely to be cured when the cancer is treated in its early stages. More than 85% of people with melanoma diagnosed 15 years ago are alive and well today with no sign of the disease. This percentage has grown steadily over the years with early detection and treatment, so more people can expect to be cured. Other factors can influence your prognosis. For example, melanomas on the arms or legs have a better prognosis than those on the trunk, head or neck.
Overall, women seem to fare better than men, although it is unclear just why this is so. You will need to talk with your doctor about your own prognosis. Your medical history is unique, so you will need to discuss with someone who knows your medical history what you can expect and the treatment options that are best for you.
You may consider taking part in a clinical trial. Clinical trials are a vital part of the search to find better treatments for cancer. Doctors conduct clinical trials to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. However, the decision to take part in a clinical trial is always yours. If you are considering taking part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
- Which treatments are being tested and why?
- Which tests are involved?
- What are the possible risks or side effects?
- How long will the trial last?
- Will I need to go into hospital for treatment?
- What will I do if any problems occur while I am in the trial?
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be allocated at random to receive one treatment or the other. In clinical trials, people’s health and progress are carefully monitored. If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not affect your treatment for cancer. It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you.
Most of this material was taken from a patient information publication of Cancer Council Victoria entitled “Melanoma”. We are grateful for their cooperation in allowing this material to be reproduced here.