Melanoma

Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).

CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.

Cytokines are proteins in the body that activate the immune system. Interferon and interleukin-2 (IL-2) are man-made versions of cytokines that are sometimes used to treat patients with advanced-stage melanoma. Interferon is injected intravenously or under the skin and can slow the growth of melanoma cells. It may be offered in addition to surgery for patients with melanoma that has spread to regional lymph nodes (Stage III disease) in order to help prevent further spread of the disease and help prolong survival.

Mast/stem cell growth factor receptor (SCFR) is a protein in humans that is encoded by the KIT gene. Active mutations in this gene are associated with a small percentage of melanomas. C-KIT mutations also help the melanoma cells to grow and divide more quickly. The mutations are commonly found in melanomas that originate on the palms of the hands, the soles of the feet, or underneath the fingernails (called acral melanomas); inside the mouth or other mucosal (wet) areas; and on parts of the body chronically exposed to the sun.

For patients with advanced-stage melanoma, immunotherapy may improve the body’s natural immune response to cancer. Immunotherapy recruits the body’s own immune system and uses it to fight cancer all over the body, making it difficult for cancer cells to hide or develop defenses against it. Immunotherapy has the potential to keep working even after the patient has completed treatment.

Intensity-modulated radiation therapy (IMRT) is a type of external beam radiation therapy that delivers beams of radiation customized to the shape and size of the tumor. This allows the radiation oncologist to deliver the maximum amount of radiation to the tumor while sparing the surrounding healthy tissue.

In rare cases, melanoma may spread as multiple deposits to the skin that are local to the original melanoma. Isolated limb perfusion is a localized form of chemotherapy used for treating these multiple metastatic melanomas that have spread to the skin on one arm or one leg. The treatment allows high doses of the chemo drug to be administered to the cancer site without endangering the rest of the body. It separates the blood flow of the limb with cancer from the rest of the body for a short period of time. During this period, high doses of the chemo drug are given into the limb.

If the physician performs a sentinel lymph node biopsy, and cancer is found in the sentinel nodes, it is likely a lymph node dissection will be advised to remove the other lymph nodes in the area.

The most common treatment for melanoma is a surgical procedure called a wide local excision. During this procedure the melanoma is completely removed together with a margin of the surrounding healthy skin. How much healthy skin is removed depends on the depth of the growth. The margin is examined under a microscope for any remaining cancer cells. If no cancer cells are found, no further surgery is necessary. Many times, a wide local excision can cure early-stage melanoma.

Mohs surgery removes less healthy tissue than excisional skin surgery. The Mohs surgeon cleans and numbs the area of skin to be operated on. Then he or she removes the visible portion of the tumor and a very small margin of healthy skin. The Mohs surgeon examines the tissue under a microscope for cancer cells. If part of the tumor is still present, the Mohs surgeon carefully maps out the area where the tumor remains and only removes additional skin in the area where the margin shows the tumor. The process is repeated until the tumor is completely removed. This type of surgery is typically reserved for melanomas on the face where it is beneficial to conserve as much healthy skin as possible during surgery.

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation can be delivered internally through seed implantation or externally using linear accelerators.

If the surgeon is required to remove a large piece of skin in order to remove the melanoma in its entirety, a reconstructive surgical procedure may be required to close up the skin. This may involve removing skin from another part of the body, such as the upper thigh, to cover the site where the skin cancer was removed. This is called a skin graft. Alternatively, the surgeon may rotate a portion of skin from a neighboring area to cover the site. This is called a skin flap.

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. Usually, targeted therapy does less damage to normal cells than other cancer treatments.