A patient's treatment choices depend on the size and location of the melanoma and the stage or extent of the disease. A doctor also considers the patient's age and general health when deciding which treatment plan(s) to recommend. The patient considers these recommendations based on a range of personal factors as well.
Many people want to learn all they can about their disease and their treatment choices so that they can take an active part in decisions about their medical care. They are likely to have many questions and concerns about their treatment options. Most patients also want to know how they will function after treatment and whether they will have to change their normal activities.
The doctor may recommend a specific treatment or may offer more than one and ask the patient to decide which one he or she would like to follow. Patients often have a hard time making this decision. It is important that a patient take the time he or she needs to make the best decision.
The doctor is the best person to answer a patient's questions, such as what treatment choices are, how successful it is expected to be, and what the risks and side effects may be.
Treatment for melanoma may be local, systemic, or both. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy, targeted therapy, and biological therapy (immunotherapy) are systemic treatments. A patient may have just one treatment or a combination of treatments.
It is important to understand the goals treatment.
A number of treatments are available for melanoma. Patients will want to consider both the benefits and possible side effects of each option, and will want to discuss any other concerns they have with their doctor before making a decision.
Different types of treatments have different goals. Below is a list of treatments and their respective goals:
Surgery. The goal of surgery is to remove the melanoma, while leaving as much of the surrounding skin intact.
Radiation therapy. The goal of radiation is to kill cancer cells using high energy X-rays or other radioactive particles. It may be used after surgery to try to kill any remaining cancer cells. It may also be used to help treat melanoma that has come back after initial treatment or has spread to distant parts of the body.
Chemotherapy. The goal of chemotherapy is to kill tumor cells directly to shrink tumors that cannot be removed by surgery or that have spread to distant areas of the body (this is called metastatic melanoma). Chemotherapy may be used for other situations in clinical trial settings.
Biological therapy. Biological therapy (immunotherapy) includes treatment with substances that modify the immune system. Antibody therapy, vaccine therapy, and other treatments are examples and are based on specific knowledge of the biology of the tumor cells and of our bodies' defenses against them. Interferon and interleukin-2 (IL-2) have been used for many years. Both drugs can help shrink advanced (stage III and IV) melanomas in some patients when used alone. These drugs may also be given along with chemotherapy for stage IV melanomas. Yervoy (ipilimumab) is a newer drug that boosts the immune system and has been shown to be helpful for advanced melanomas.
Targeted therapy. Some newer drugs target specific parts of melanoma cells. For example, a newer drug, called Zelboraf (vemurafenib), targets a gene change found in about half of all melanomas. It can often cause advanced melanomas with this gene change to shrink
Doctors are always finding new ways to treat melanoma. These new methods are tested in clinical trials. Before beginning treatment, a person should ask their doctor if there are any clinical trials they should consider.
At first, the information a patient receives about treatment options may seem overwhelming. It is important that patients take the time to gather as much information as possible about their disease and its treatment, and to discuss the issues with their doctors, nurses, and loved ones. Many people find it helpful to make a list of questions before seeing their doctor.