Today there are more treatment options than ever for melanoma. If melanoma or suspicious tissue is detected during a mole mapping scan and examination, the Melanoma and Skin Care Center (MSCC) offers a wide variety of treatments and therapies based on the stage of the melanoma and your individual patient history:
Surgery is usually the first treatment for melanoma skin cancer. If melanoma is detected early, when it can be removed, surgery is likely to be successful. During surgery, also called resection or excision, the tumor is cut away. The margins of skin, where healthy tissue borders the tumor, are checked in pathology. This determines if the skin is free of cancer or if additional surgery is required. The thicker the melanoma, the wider the margins are that must be removed during surgery.
Highly abnormal precancerous moles or other skin lesions may require only a simple excision. They are surgically removed along with their margins during local anesthesia. A simple excision has less width than a wide local excision.
Wide Local Excision
After the lesion has been diagnosed as a melanoma, a wider excision is required. An excision of .05cm – 2cm is made around the tumor, depending on its thickness, and the cancerous tissue and margins are sent to pathology. Further surgery, such as sentinel node biopsy, or other treatment options may be pursued.
Sentinel Lymph Node Biopsy
Sentinel lymph node biopsy is performed in patients with melanomas greater than 1mm thick or with smaller tumors that show characteristics such as ulceration or active growth. During surgery, radioactive solution or colored dye is injected near the tumor as a way to find the sentinel lymph nodes. The nodes bearing the dye are removed and sent for biopsy. If cancer is present, more lymph nodes may be resected. Because sentinel nodes are usually the first part of the lymphatic system to see the spread of the disease (metastasis), sentinel lymph node biopsy is also used in determining prognosis.
This surgery is used in areas such as the face where every millimeter of skin is at a premium. A small layer of tissue is removed and then examined during Mohs surgery; this process is then repeated until the tissue is free of cancer. Mohs surgery conserves the most tissue possible by precisely removing cells layer by layer. (Mohs has the highest rates of success in treating basal and squamous cell carcinomas.)
Immunotherapy, sometimes called molecular therapy, consists of administering biologic agents that stimulate the immune system. Antibodies or man-made cytokines (interferons and interleukins) are typically used to treat patients with metastatic melanoma, sometimes as adjuvant therapy. Substances may be used alone or as part of combination therapy. Improvements in survival, progression, or recurrence have been demonstrated in comparison to other treatments. However, side effects may be severe.
FDA approved in 2011 for the treatment of metastatic melanoma, ipilimumab works by stimulating T-cells. Improvements in overall survival have been shown in randomized trials.
FDA approved to treat patients with metastatic melanoma who are not responding to other treatments, Pembrolizumab is used after treatment with ipilimumab and, in patients with the BRAF V600 mutation, targeted therapy. Pembrolizumab blocks the cellular pathway PD-1 form restricting immune response.
Interferon Alpha 2-b
Interferon alpha 2-b is a standard adjuvant therapy for patients who have had prior surgery for metastatic melanoma and are at high risk of recurrence.
Approved in 1998, interleukin or IL-2 is used intravenously in high doses to treat patients with metastatic melanoma who are otherwise medically fit. In patients treated with IL-2, melanoma disappeared or stopped progressing for periods over 5 years. Long term survival rates are not known due to a lack of data.
The aim of targeted therapy is to inhibit or stop cell division of cancer cells without harming healthy cells. Over half of all advanced melanomas have BRAF gene mutations that make proteins which regulate cells and signal rapid growth. Drugs that inhibit BRAF or MEK protein enzymes target and block these signals, resulting in tumor regression. Several targeted therapy drugs, alone or in combination, were recently approved for treatment by the FDA.
Vemurafenib is a BRAF protein enzyme inhibitor approved in the treatment of late stage melanomas in patients with the V600E mutation in BRAF.
Trametinib is a MEK inhibitor approved for the treatment of late stage melanoma in patients with the V600E mutation in BRAF.
Dabrafenib plus Trametinib
Dabrafenib, like trametinib, is approved for the treatment of late stage melanoma in patients with the V600E BRAF mutation. However, each works on different parts of the same gene pathway. Dabrafenib is used in combination with trametinib or alone.
One of our most important objectives is to bring to patients the observations and advances made in the laboratories. This approach has produced innovative clinical studies that have improved patient treatment methods. Our physicians make important discoveries in the war against cancer, analyze the information gathered in their treatment and research activities, and train the health professionals and scientists of tomorrow.
The University of Illinois at Chicago has membership in national cooperative clinical trials groups, bringing together thousands of oncology specialists to collaborate in clinical research studies. These groups include the Cancer and Leukemia Group B (CALGB) and the American College of Surgeons Oncology Group (ACOSOG). The wealth of knowledge shared by these groups brings to our patients the most advanced treatment options currently available.
Currently active clinical trials investigate the role of the following therapies:
Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Bevacizumab or Ipilimumab as First-Line Therapy in Treating Patients with Stage IV Melanoma that Cannot be Removed by Surgery
This randomized phase II trial studies how well paclitaxel albumin-stabilized nanoparticle formulation and bevacizumab oripilimumab works as first-line therapy in treating patients with stage IV melanoma that cannot be removed by surgery. Drugs used in chemotherapy, such as paclitaxel albumin-stabilized nanoparticle formulation, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab and ipilimumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether paclitaxel albumin-stabilized nanoparticle formulation and bevacizumab is more effective than ipilimumab in treating melanoma.
Study Comparing Combination of LGX818 plus MEK162 and LGX818 Monotherapy versus Vemurafenib in BRAF Mutant Melanoma (COLUMBUS)
A prospective, randomized, open label, multi-center, parallel group, 3-arm phase III study comparing the efficacy and safety of both, LGX818 plus MEK162 and LGX818 monotherapy, as compared to vemurafenib in patients with locally advanced unresectable or metastatic melanoma with the BRAF V600 mutation.
Ipilimumab or High-Dose Interferon Alfa-2b in Treating Patients with High-Risk Stage III-IV Melanoma that has been Removed by Surgery
This randomized phase III trial studies ipilimumab to see how well it works compared to high-dose interferon alfa-2b in treating patients with high-risk stage III-IV melanoma that has been removed by surgery. Monoclonal antibodies, such as ipilimumab, may interfere with the ability of tumor cells to grow and spread. Interferon alfa-2b may interfere with the growth of tumor cells and slow the growth of melanoma and other cancers. It is not yet known whether ipilimumab is more effective than interferon alfa-2b in treating patients with melanoma.
Chemotherapy is used to treat metastatic melanoma that has spread outside its site of origin. Various chemotherapy drugs may be administered by pills or injections in cycles of perhaps three or four days, followed by weeks without chemotherapy. Because chemotherapy drugs are toxic to healthy blood cells as well as cancerous cells, blood cell counts are monitored. Side effects include severe flu-like symptoms such as nausea, fatigue, and infection.
Isolated Limb Perfusion
If the spread of melanoma is limited to an arm or leg only, isolated limb perfusion or ILP may be used to give very high doses of chemotherapy to the cells in the limb while protecting the rest of the body. A tourniquet is applied to the limb, and a chemotherapy drug is pumped into the blood through the artery by means of a tube. A second tube is used to drain the blood into a machine, where it is processed by a machine and returned to the limb. Eventually the drug is completely removed.