Treatment for Melanoma
The standard treatment for primary melanoma is surgical removal. During this procedure, the tumor and an area of surrounding healthy tissue (called margins) is removed. The size of these margins depends on the depth of the tumor. Melanoma that remains confined to the skin is almost 100% curable.
Therapy for melanoma that has spread to lymph nodes or to distant sites exists. Adjuvant, or additional, therapy includes immunotherapy using interferon alpha 2b or interleukin-2. These are immune-stimulating chemicals that helps the body "fight" the cancer. Some studies show that these medications can prolong one's life. But the medication is difficult to tolerate. Virtually all patients experience flu-like symptoms that can be quite severe. Treatment-related deaths have been reported as well. In experiments with lower doses, patients tolerate the medication better and live a little longer.
Various chemotherapy regimens are used to treat metastatic disease, although the results are typically disappointing. Chemotherapy is sometimes combined with immunotherapy. Radiation therapy can relieve some of the pain caused by complications associated with metastatic tumor by reducing the size of a tumor located in the brain, the bones, the skin, or spinal cord.
In March 2011, the U.S. Food and Drug Administration (FDA) approved ipilimumab (Yervoy) to treat metastatic melanoma. This drug, which is a monoclonal antibody, may help the body's immune system to recognize, target, and destroy melanoma cells. In an international study, ipilimumab improved survival in patients with late-stage disease. Side effects include diarrhea, fatigue, rash, and intestinal inflammation. This medication increased the risk for severe autoimmune reactions and its approval includes a strategy (Risk Evaluation and Mitigation Strategy) to inform doctors of these serious risks.
In August 2011, vemurafenib (Zelboraf) was approved to treat a certain type of melanoma that cannot be treated surgically and/or that has spread (metastasized). This drug may be used for late-stage melanoma that contains a certain genetic mutation called BRAF V600E. Also included in this approval is a diagnostic test to identify the specific mutation. Side effects include joint pain, rash and sun sensitivity, hair loss, fatigue and nausea.
A major development in treatment is the melanoma vaccine. The vaccine prompts the patient s immune system to recognize and kill the remaining tumor cells before they reproduce and grow. The melanoma vaccine has an overall response rate of 10% to 20%. Attempts to increase the immune-stimulating effects of the vaccine are being undertaken.
