melanoma

HOW IS MELANOMA TREATED?

HOW IS MELANOMA TREATED?


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  • - JANELLE CYR
  • - M.D.C.M | PGY-3 DERMATOLOGY
  • - UNIVERSITY OF TORONTO

Treatment of melanoma depends on the size, stage and location of the tumor and is different for every individual. Melanoma of the nail, for instance, can be treated differently than the melanoma of the eyelid

SURGERY

Excision is often performed when the melanoma has not spread. Usually the melanoma is excised with skin around it called “margins” that can vary from 0.5cm - 2.0cm and are based on the tumour thickness. During the excision the dermatologic surgeon will excise all skin and subcutaneous tissue deep down to the underlying fascia (covering) of the muscle. This is done to ensure that all cancer cells are removed. The removed piece of skin is sent to pathology to confirm that the margins are free or “clear” of cancer. When the cancer is large, sometimes a skin graft or flap (skin from a nearby area is used to help close the wound) is required.

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RADIATION THERAPY

External beam radiation therapy uses a machine with high energy beams to kill cancer cells in a targeted fashion. Sometimes this is used in addition to surgery or chemotherapy. Radiation therapy can have significant side effects such as a sunburn like rash, swelling of nearby tissues (lymphedema) and scarring or hair loss of the treated skin. Radiation is not commonly used to treat melanoma since it is often resistant to this type of treatment.

CHEMOTHERAPY

Chemotherapy are a class of medications delivered by tablet or infusion that destroy cancer cells. Chemotherapy can be used in addition to surgery, radiation, or immunotherapy. The most commonly used chemotherapy medications for the treatment of melanoma are dacarbazine, temozolomide, carboplatin, paclitaxel, cisplatin, and vinblastine. Chemotherapy medications can have significant side effects which include decreasing the body’s immune system by lowering the blood cell counts, fatigue, hair loss (anagen effluvium), and gastrointestinal issues (diarrhea, nausea and vomiting). Rarely, chemotherapy can be applied as a cream to the affected areas. This is a less effective treatment, but can be used in palliative care cases or in patients who are unable to tolerate other treatment options. Similarly to radiation, chemotherapy is not viewed as the main way of treatment for melanoma.

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IMMUNOTHERAPY AND TARGETED THERAPIES

Immunotherapy medications are a class of drugs that help strengthen the body’s immune system to fight the cancer itself. Examples of these medications include pembrolizumab, nivolumumab, ipilimumab and historically (now used less often) interferon alfa-2b, and interleukin-2. These medications are typically delivered by an infusion or injection. Since these medications activate the body’s immune system, it is common to have side effects that are similar to the flu such as fever, chills, and gastrointestinal symptoms (diarrhea, nausea and vomiting). Currently, immunotherapy medications hold the best promise of treating advanced and metastatic melanomas in patients. Targeted therapy medications target specific mutations that are present in some melanomas and help to shrink the cancer. When a melanoma is biopsied or excised, certain special tests can be ordered on the skin sample to determine if the cancer cells have mutations that make them susceptible to these therapies. For example, BRAF mutations can be targeted by dabrafenib or vemurafenib and MEK mutations can be targeted by cobimetinib or trametinib. Unfortunately, not all melanomas possess the susceptible mutations. Targeted therapies are usually a pill taken once a day. Some patients can develop various side effects to these therapies