Treatments for locally recurrent melanoma skin cancer
The following are treatment options for locally recurrent melanoma skin cancer. Locally recurrent means that the melanoma skin cancer has come back after it has been treated in the same place or close to where the cancer started. Your healthcare team will suggest treatments based on your needs, including the location of the recurrence. They will work with you to develop a treatment plan.
The most common place for local recurrence is on skin close to where the cancer started (satellite tumours) or in nearby lymph vessels (in transit metastases). The cancer may also come back in the area of the original scar or in nearby lymph nodes (also called a regional or nodal recurrence).
Surgery is usually offered for locally recurrent melanoma skin cancer.
Wide local excision (sometimes called surgical resection) is done to remove a tumour on the skin and a small amount of healthy tissue around it (called the surgical margin). Sometimes more tissue is removed if cancer cells are found in the surgical margin. Many excisions can be done.
Sentinel lymph node biopsy (SLNB) may be done for locally recurrent melanoma skin cancer to help doctors decide if other treatment is needed. It is only done if it was not done before. 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.
Complete lymph node dissection is done to remove a group of lymph nodes. It is usually done if melanoma skin cancer comes back in nearby lymph nodes. It may also be done if a sentinel lymph node biopsy shows there are cancer cells in the sentinel lymph node (or lymph nodes). A complete lymph node dissection can be done at the same time as the wide local excision or during another surgery. The type of lymph node dissection done depends on which and how many lymph nodes contain cancer.
Reconstructive surgery may be done if a large area of skin is removed because there are many tumours grouped close together. It repairs the skin and nearby area where the 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.
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You may be offered radiation therapy for locally recurrent melanoma skin cancer. Most often it is used as palliative therapy to control symptoms when surgery can’t be done.
External beam radiation therapy is aimed at the area of skin where the cancer and lymph nodes were removed. It is usually given once a day. How long it is used depends on the number and size of metastases, the type and dose of radiation therapy used, how severe symptoms are and other factors.
You may be offered immunotherapy for locally recurrent melanoma skin cancer. It is used when there are many tumours that can’t be removed with surgery. Interleukin-2 (aldesleukin, Proleukin) is the immunotherapy drug used. It is injected directly into a tumour (called intralesional treatment).
Chemotherapy given directly into an arm or leg (also called regional chemotherapy) is rarely used, but may be offered for locally recurrent melanoma skin cancer that is only in one limb. It can be done when there are many large tumours that can’t be removed with surgery.
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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.
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.