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Treatments

  • Surgery

    The most common treatment for melanomas (90 percent of cases) is surgery. We will determine the most appropriate surgical procedure and provide expert skin replacement for any skin damaged during cancer removal.

    • Wide Local Excision: The melanoma and some of the normal tissue around it are cut out in surgery. The size of the excision is based on the tumor thickness and how deep the melanoma invades into the skin layers. For some facial melanomas, a staged contoured excision may be recommended to plan for final plastic surgery reconstruction.

    • Lymph Node Sampling: Enlarged lymph nodes that can be felt by hand will be removed and biopsied to check for cancerous cells.

    • Sentinel Lymph Node Biopsy: The sentinel lymph node is the first lymph node to which cancer cells are likely to spread. It is identified, removed, and examined to determine cancer presence, the extent of the disease and a recommended treatment plan.

    • Lymphadenectomy: If cancer cells are found, the doctor will remove more lymph nodes and check tissue samples for signs of cancer. A regional lymphadenectomy involves just some of the lymph nodes being removed. A radical lymphadenectomy will remove most or all of the lymph nodes in the tumor area.

  • Chemotherapy

    Drugs administered intravenously, by oral pill, or by intra-arterial chemotherapy

    • Regional Chemotherapy ILI: If you have melanoma in an extremity that is not easy for surgery, or if you are not a candidate for surgery, we may offer isolated limb infusion (ILI). This delivers high local doses of chemotherapy for melanomas in the arms and legs and avoids damage to other tissue. You are hospitalized until the limb inflammation subsides.

    • Systemic Chemotherapy: Traditional chemotherapy delivered intravenously (by vein) or by mouth (pill form) that affects the entire body, in order to destroy cancer cells. Less frequently used for melanoma because of newer, more improved targeted therapies.

  • Immunotherapies

    Also called biologic therapies, these drugs boost the power of the body’s immune system to fight cancer. Biologic therapies under study for melanoma include:

    • Intra-tumor immunotherapy injections: A targeted drug or a combination of drugs or oncolytic virus are injected into tumors or lymph nodes that cannot be surgically removed due to too much tumor, its location, or because you cannot tolerate a surgical procedure.

    • Checkpoint Inhibitor Monoclonal Antibodies and Checkpoint Blockade Drugs: These treatments take advantage of immune T cells that are present in many tumors, but that have been shut off by cancer cells.

    • Interferon: This drug affects the division of cancer cells and can slow tumor growth.

    • Interleukin-2 or IL-2: This medicine enhances immune cells, especially lymphocytes, to kill cancer cells.

  • Targeted Therapy

    Targeted therapies are treatments using drugs or other substances to attack cancer cells, usually causing less harm to normal cells than chemotherapy or radiation therapy.

    • Signal Transduction Inhibitor Therapy: These drugs block signals that are passed from one molecule to another inside a cell. Different types (e.g., BRAF, MEK inhibitor therapies) are used to treat people with advanced melanoma or who have tumors that cannot be removed by surgery.

    • Oncolytic Virus Therapy: In this therapy, a virus is used to infect and break down cancer cells, but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.

    • Angiogenesis Inhibitors: Drugs that block the growth of new blood vessels in tumors to starve them.

  • Radiation Therapy

    Radiation therapy is selectively used for some melanomas, such as tumors too large or located in difficult to treat areas. This may be the best option for patients with other medical complications. High-energy X-rays deliver a hefty daily dose of radiation over a period of two and a half weeks.

    • MRIdian System™ (also called ViewRay™):  We are one of few centers in the world equipped with this radiation delivery system that can acquire magnetic resonance imaging (MRI) images during treatment delivery. This tumor tracking tool better targets the tumor and spares more surrounding healthy tissue. It’s not used for superficial skin cancers, but is often indicated for tumors inside the brain, chest and abdomen or pelvis.

    • Stereotactic Body Radiation Therapy (SBRT): This radiation therapy comes from many different positions around the tumor. A high dose of radiation is directed at the cancer, but special care is taken to limit the exposure to healthy surrounding tissue.

  • Standard Treatments for Merkel Cell Skin Cancer

    For Merkel cell carcinoma, surgical excision, sometimes sentinel lymph node biopsy for certain size tumors, and clinical trials may be suggested.

    Radiation therapy is generally used to deliver a more conventional daily dose with each treatment over a period of five weeks as either the only treatment or as an adjunct to surgery to prevent local or regional relapse in the draining lymph node chain.