There are several treatment options for melanoma, all of which are dependent on your stage of diagnosis. Surgery is the mainstay of therapy, especially for early stage melanoma. We also offer other advanced therapies that may be better suited to the patient's needs. We discuss all treatment options with you and develop the most effective course of action to manage your disease and achieve the best possible outcome.
Treatment of primary melanoma that is localized is surgery. Wide excision is a procedure where the doctor surgically removes the tumor and some normal skin around the tumor to ensure that all cancer cells have been taken out.
Sentinel Lymph Node Biopsy
If you have been diagnosed with melanoma, your doctor's team will do tests to find out if the melanoma has spread to lymph nodes near the tumor. When you have melanoma, cancer cells can break away from a tumor, enter the lymph fluid, and gather in the nearby lymph nodes. Sentinel lymph node is the first lymph node to receive cancer cells from the tumor. Sentinel Lymph Node Biopsy (SLNB) is a minimally invasive procedure developed to identify patients with nodal metastases (cancer cells have spread to the lymph node) and who could be candidates for complete lymph node dissection (CLND) where more extensive removal of lymph nodes is performed. A doctor injects a radioactive substance directly adjacent to the melanoma or biopsy scar and in addition, a blue die is also injected near the tumor or the biopsy scar. The dye travels along the lymph channels to the first lymph node, called the sentinel lymph node. This node is removed and microscopic exam is performed to determine whether cancer cells are present. If none are found, it is unlikely that the cancer has spread to other lymph nodes. Usually, no further treatment is needed. If cancer is present, the surgeon may need to remove additional lymph nodes.
For a local recurrence after adequate prior wide excision and in the absence of extraregional disease, surgery to remove the tumor is recommended. Approximately half of newly diagnosed cases of melanoma are isolated to the upper or lower limbs, and in up to 10% of these cases recurrence takes place in the same limb where the primary diagnosis was made. For patients with recurrent melanoma that is confined to a limb and cannot be cured by surgical means, a procedure called Isolated Limb Perfusion (ILP) can be offered. ILP provides an alternative to an amputation. This method allows for large doses of chemotherapy to be delivered to limb only, leaving the rest of the body unaffected. Montefiore is among a select group of medical centers nationwide to offer ILP and Isolated Limb Infusion (ILI), a simplified, minimally invasive procedure offered for poor surgical candidates as an alternative to ILP.
Metastatic melanoma is associated with a poor prognosis. Among the melanoma treatment options at Montefiore are traditional chemotherapy as well as FDA-approved immunotherapies such as ipilimumab and Interleukin-2 (IL-2), which have been shown to improve survival in some patients, radiation therapy, clinical trials. B-RAF inhibitors, which are linked to suppressing the activity of tumors, are available to patients through research protocols.