Treatment - What is Melanoma? - Cancer Council Victoria

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Tuesday 30 June, 2009

Reviewed: Prof. John Kelly, Dermatologist;
Mr David Speakman, Head, Melanoma and Skin Service, Peter Mac

Most people with melanoma need to have surgery. In some cases melanoma may betreated by surgery,radiotherapy, chemotherapy and other drugs. Some new treatments, such as vaccines, are tested in clinical trials .

Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what's 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.

Surgery

Melanomas are usually removed by surgery. First, the mole or spot is cut out along with a small area of normal-looking skin around it. This is sent for pathology testing.

If the pathology confirms the diagnosis of melanoma, most people need to have a second procedure. This removes more normal-looking skin around the melanoma. It's called a ‘margin of safety'. The margin varies from 5 mm to 2 cm, depending on the depth of the melanoma. The purpose is to remove any cancer cells in the surrounding skin and prevent the melanoma growing back at the same site.

Repairing the wound

Most people will be able to have their skin sewn up with normal stitches and without having a skin graft or skin flap.

The surgeon sometimes needs to take some extra tissue to close the wound:

in a skin graft, the surgeon takes a layer of skin from another part of your body and uses it to cover the wound
in a skin flap, the surgeon safely closes the wound with a nearby flap of skin and fatty tissue.

The decision about whether to do a skin graft or flap will depend on many factors, such as where it is on the body, how much tissue has been removed and the person's general health.

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 until it's fully healed.

You may be uncomfortable for some days after your operation. If you have pain, tell your doctor or nurse so that they can give you pain-relievers.

If you have a skin graft, the area where the skin is grafted on may look unattractive immediately after the operation, but it will heal and the redness will fade. After surgery for melanoma there is a risk of infection, of a blood clot forming in the wound, and scarring. Occasionally, the skin graft fails: if this happens to you, your doctor will explain what further treatment you will need.

You can help your recovery and healing by resting and when possible raising the limb from which the cancer was removed.

Recovery time will depend on many factors but especially the extent of your surgery and whether you had a skin graft or flap. If extra skin tissue was needed, then recovery will usually be a little longer but you should still have an excellent long-term result.

Radiotherapy

Radiotherapy treats cancer by using radiation to destroy or injure cancer cells. The radiation can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.

You'll 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's quite safe to be close to your partner, children and others during the course of treatment.

Side effects of radiotherapy

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 which part of the body is treated. Talk with your doctor or the radiotherapy staff about any possible side effects and how to manage them.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.

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. Your medical oncologist will discuss these options with you.

Side effects of chemotherapy

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. The medical oncologist will discuss these and other side effects and risks with you.

Complementary and alternative therapies

It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.

Complementary therapies include massage, meditation and other relaxation methods that are used along with medical treatments. Alternative therapies are unproven remedies including some herbal and dietary remedies that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even harmful.

Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treat-ment. However, some alternative therapies are harmful, especially if:

you use them instead of medical treatment
you use herbs or other remedies that make your medical treatment less effective
you spend a lot of time and money on alternative remedies that simply don't work.

Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline 13 11 20.

The website of the US National Center for Complementary and Alternative Medicines also has more information.

Prognosis

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's unclear why.

You'll 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.

Risk of further melanomas: follow-up

Most people treated for early melanoma do not have further trouble with the disease. However, when there's a chance that the melanoma may have spread to other parts of your body, you'll need regular check-ups. Your doctor will decide how often you'll need check-ups: everyone is different. They'll become less frequent if you have no further problems. A check-up by a doctor at least yearly is recommended, as people who've had one melanoma are at increased risk of another in the future.

If you're part of a family where 2 or more close relatives have been diagnosed with melanoma, you and your family may benefit from referral to a family cancer centre. The centre can assess the risk of melanoma in all family members and give ap-propriate advice. Call 13 11 20 for details about family cancer centres.

Protecting your skin

After treatment for melanoma, it's very important to limit exposure to the sun's UV. People who have a history of melanoma are at increased risk of future melanoma. Increased sun protection at any age can help to prevent further damage and skin cancer. You should also talk with your doctor about monitoring your vitamin D levels.

The SunSmart UV Alert is a tool you can use to protect yourself from UV radiation. It tells you the time during the day you need to use sun protection. The alert times are issued throughout the year by the Bureau of Meteorology (BOM) when the UV Index is forecast to reach 3 or above. At the level of 3 and above, UV radiation can damage your skin and eyes and may lead to skin cancer. So whenever SunSmart UV Alert times apply, you need to use sun protection.

You can find the SunSmart UV Alert on the weather page of daily newspapers or on the Bureau of Meteorology website.

Live UV levels for Melbourne are also available at www.arpansa.gov.au/uvindex/realtime

Whenever the UV Index level reaches 3 or above, the Cancer Council recommends you take five simple steps to protect yourself:

Slip on some sun-protective clothing that covers as much skin as possible.
Slop on SPF30+ sunscreen. Make sure it is broad spectrum and water resistant. Put it on 20 minutes before you go outdoors and every two hours afterwards. Sunscreen should never be used to extend the time you spend in the sun.
Slap on a sun hat that protects your face, head, neck and ears.
Seek shade.
Slide on some sunglasses. Make sure they meet the Australian Standard (AS 1067).

The general rule of thumb in Victoria is as follows:

From September to April the UV Index forecast for the day is usually 3 or above for most of the day. Extra care should be taken between 10 am to 3 pm when UV Index levels reach their peak.
From May to August UV radiation levels are generally low (below 3). Sun protection isn't needed unless you are in alpine areas or near highly reflective surfaces such as snow or water.