Treatments for early stage melanoma skin cancer
The following are treatment options for early stage melanoma skin cancer. Early stage melanoma skin cancer is only in the skin, including stage 0 (melanoma in situ), stage 1A, stage 1B, stage 2A, stage 2B and stage 2C. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Surgery is the standard treatment for early stage melanoma skin cancer. It is often the only treatment needed for most early stage melanoma skin cancers.
Wide local excision is done to remove the tumour and a small amount of healthy tissue around it (called the surgical margin). The size and depth of the surgical margin depends on how thick the tumour is and where it is located on the skin.
Sentinel lymph node biopsy (SLNB) may be offered for early stage melanoma skin cancer. SLNB finds and removes the first lymph node (or first few lymph nodes) in a group of lymph nodes to see if it contains cancer cells. An SLNB may be done if the melanoma skin cancer is more than 1 mm thick. Doctors may also consider doing an SLNB for slightly thinner tumours (0.75 mm to 1 mm thick) with ulceration or a mitotic rate of 1/mm2.
Reconstructive surgery may be done if a large area of skin has been removed when the surgeon wants to make sure the cancer is completely gone. Reconstructive surgery repairs the skin and nearby area after melanoma skin cancer is removed. The doctor takes a piece of skin from another part of the body, called a skin graft or skin flap, to rebuild the area.
You may be offered immunotherapy after surgery for early stage melanoma skin cancer. It is mainly used if cancer cells were found in the sentinel lymph node or for people who have a high risk of the cancer coming back (recurring).
Interferon alfa-2b (Intron A) is the immunotherapy drug used. It is given by injection several days each week for 1 year.
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Radiation therapy may be offered after surgery for certain cases of early stage melanoma skin cancer. It can be used for people who have increased risk of the cancer coming back in the same area where the cancer was removed (local recurrence) if:
- cancer cells are still in the surgical margin around the tumour but more surgery is not possible
- it is desmoplastic melanoma
- the tumour is more than 4 mm thick, especially when there is ulceration (stage 2C)
- the melanoma skin cancer is on the head or neck, especially when it is mucosal melanoma
External beam radiation therapy is aimed at the area of skin where the cancer was removed and sometimes at the area of nearby lymph nodes. It is usually given daily for several weeks.
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Alberta Health Services. Sentinel Node Biopsy in Primary Cutaneous Melanoma Clinical Practice Guideline CU-011 (version 5). 2016: http://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-cu011-regional-node-dissection.pdf.
American Society of Clinical Oncology. Melanoma. 2015: http://www.cancer.net/cancer-types/melanoma/view-all.
Cancer Care Nova Scotia. Guidelines for the Management of Malignant Melanoma. 2013: http://www.cancercare.ns.ca/site-cc/media/cancercare/2014Management%20of%20Malignant%20Melanoma.pdf.
Cancer Care Ontario. Evidence-Based Series Guideline 8-9 (Summary): The Use of Adjuvant Radiation Therapy for Curatively Resected Cutaneous Melanoma. 2016: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=351575.
Cancer Care Ontario. Evidence-Based Series Guideline 8-1 (Summary): Systemic Adjuvant Therapy for Patients atHigh Risk for Recurrent Melanoma. Version 4 ed. 2013: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=14216.
Keidan RD. Medscape Reference: Sentinel Lymph Node Biopsy in Patients With Melanoma. 2014: http://emedicine.medscape.com/article/854424-overview.
National Cancer Institute. Melanoma Treatment for Health Professionals (PDQ®). 2016: http://www.cancer.gov/types/skin/hp/melanoma-treatment-pdq.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Melanoma (Version 2.2016). 2016.
Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Melanoma. 2015: http://www.uhn.ca/PrincessMargaret/Health_Professionals/Programs_Departments/Melanoma_Skin_Oncology/Pages/clinical_practice_guidelines.aspx.
Ribas A, Slingluff Cl Jr, Rosenberg SA . Cutaneous melanoma. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 94:1346-1394.