Treating advanced melanoma

Thursday 1 January, 2015

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On this page: Surgery | Radiotherapy | Chemotherapy | Targeted therapies | ImmunotherapiesPalliative treatment | Key points


Advanced melanoma (also called metastatic melanoma) means the cancer has spread to distant skin sites, lymph nodes or internal organs. Treatment may include surgery, radiotherapy, immunotherapy, targeted therapies and chemotherapy.

Surgery

In some cases the surgeon will be able to do a [wide local excision] to treat metastatic melanoma that involves other parts of the skin. The surgeon will also remove nearby lymph nodes if they are cancerous. This procedure is called a lymphadenectomy or lymph node dissection.

If the melanoma has spread to internal organs, surgery may still be possible, but this will depend on a number of other factors. The type of operation you have will depend on the part of your body that is affected. Talk to your medical team for more information or call Cancer Council 13 11 20.

Radiotherapy

Radiotherapy treatment uses high energy rays to damage or kill cancer cells so they cannot multiply. It is usually used if the cancer has spread to the lymph nodes. Radiotherapy is also sometimes given after surgery to prevent the melanoma coming back and when the melanoma has spread to other parts of the body such as the bones or brain, in order to control cancer growth or relieve symptoms.

Before starting treatment you will have a planning appointment where a CT (computerised tomography) scan is performed. The radiotherapy team will use the images from the scan to plan your treatment. The technician may make some small permanent tattoos or temporary marks on your skin so that the same area is targeted during each treatment session.

During treatment, you will lie on a table under a machine that aims radiation at the affected part of your body. Treatment sessions are usually given daily over one to four weeks. The number of treatment sessions will depend on the size and location of the tumour, and your general health. Each session takes about 20–30 minutes and is not painful – similar to an x-ray.

Side effects

Many people will develop temporary side effects, such as fatigue and skin reactions during their treatment. The side effects you experience will depend on the part of the body that receives radiotherapy and how long you receive treatment.

Skin in the treatment area may become red and sore during or immediately after treatment. Ask your treatment team for advice about dealing with any side effects.

For more information see the radiotherapy section.

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells, while causing the least possible damage to healthy cells. In advanced melanoma, chemotherapy is mainly used to slow the growth of the cancer cells, or as a palliative treatment.

The number of treatment sessions and their frequency will vary according to the type of melanoma you have and the drugs used.

Side effects

Chemotherapy drugs used to treat melanoma can cause side effects, including nausea, vomiting, fatigue, and thinning or loss of hair. These side effects are temporary and steps can be taken to prevent or reduce them.

For more information see the chemotherapy section.

Targeted therapies

There have been a number of new developments in the use of targeted therapies for the treatment of advanced melanoma. They have been shown to help specific groups of people with melanoma.

These treatments work by selectively targeting particular types of cancer cells while minimising harm to healthy cells. Targeted therapies have different actions to help destroy or stop the growth of cancer cells and are generally administered into the vein (intravenously) or in tablet form (orally).

To find out if you are eligible for targeted therapy treatment, a section of melanoma tissue needs to be tested for a genetic mutation. One of the more common genetic mutations is in the BRAF gene. When abnormal, this gene signals cancer cells to multiply. Approximately 50% of people with melanoma have a mutation in the BRAF gene. The change in the BRAF gene is only found in the melanoma cells and cannot be passed from parents to children.

Immunotherapies

Immunotherapies (also called biological therapies) can stimulate the body’s immune system to fight the melanoma. Different types of immunotherapies may be used to treat advanced melanoma. These treatments are generally administered into the vein (intravenously).

Side effects will vary depending on your treatment. It is important to discuss any side effects with your doctor immediately, including changes to your mood. If left untreated some symptoms can become life threatening. For more information about targeted therapies and immunotherapies and their side effects call Cancer Council 13 11 20.

Palliative treatment

Palliative treatment seeks to improve quality of life by reducing cancer symptoms without aiming to cure the disease.

Treatment can assist with managing symptoms such as pain and nausea, as well as slowing the spread of the cancer and may include radiotherapy, chemotherapy or other medication.

It is commonly assumed that palliative treatment is for people at the end of their life; however it may be beneficial for people at any stage of advanced disease.

"I’ve been having palliative care treatment for five years. I’m not trying to get rid of the disease, just keeping it under control - and my quality of life is excellent." - Jim

For more information see the palliative care and advanced cancer sections.

Key points

  • If melanoma has spread to other parts of your body (distant skin sites, lymph nodes or internal organs), it is called advanced or metastatic melanoma.
  • Treatment for metastatic melanoma may include surgery, radiotherapy, targeted therapies, immunotherapies, chemotherapy, or participation in clinical trials. New developments are occurring all the time.
  • The surgeon will usually be able to remove the melanoma metastasis and skin around it (wide local excision). Nearby lymph nodes may also be removed in a procedure called lymph node dissection.
  • Radiotherapy uses high energy beams to kill or damage cancer cells so they cannot multiply. Side effects may include skin redness and soreness, and fatigue.
  • Targeted therapies block proteins that signal the cancer cell to grow.
  • Immunotherapies activate cells in the body to fight cancer.
  • Chemotherapy is drug treatment that kills cancer cells or slows their growth. Most of the chemotherapy drugs used to treat melanoma do not cause major side effects, but you may experience some temporary side effects such as fatigue, nausea and hair loss.
  • Palliative treatment seeks to improve quality of life without aiming to cure the cancer.

Reviewed by: Prof Bryan Burmeister, Director of Radiation Oncology, Princess Alexandra Hospital, QLD; Dr Victoria Atkinson, Senior Medical Oncologist, Division of Cancer Services, Princess Alexandra Hospital, QLD; Assoc Prof John Kelly, Head of Victorian Melanoma Service VIC; Dr Mark Hanikeri, Director WA Melanoma Advisory Service, Plastic and Reconstructive Surgeon, WA Plastic Surgery Centre WA; Lydia Visintin, Clinical Nurse Consultant, Melanoma Institute Australia NSW; Carol Hargreaves, 13 11 20 consultant, Cancer Council NSW; Julie Fraser, Peer Support Volunteer, Cancer Council QLD ; Susanna Cramb, Viertel Cancer Research Centre, Cancer Council QLD.

Updated: 01 Jan, 2015