Treatments for locoregional melanoma skin cancer
The following are treatment options for locoregional melanoma skin cancer. Locoregional melanoma skin cancer means the cancer has spread to nearby lymph nodes, or it has spread to nearby areas of skin (satellite tumours) or lymph vessels (in transit metastasis). This includes any stage 3 melanoma skin cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
If surgery can’t be done for locoregional melanoma skin cancer, doctors may treat it the same as metastatic melanoma skin cancer. Find out more about treatments for metastatic melanoma skin cancer.
Surgery is a standard treatment for locoregional melanoma skin cancer.
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.
Complete lymph node dissection is done to remove a group of lymph nodes. It can be done at the same time as the wide local excision or during a second surgery. The type of lymph node dissection done depends on which and how many lymph nodes contain cancer. A complete lymph node dissection may be done if the doctor feels any enlarged lymph nodes and a lymph node biopsy or imaging tests show that lymph nodes contain cancer cells.
In some cases, a complete lymph node dissection may be done if a sentinel lymph node biopsy shows there are cancer cells in the sentinel lymph node (or lymph nodes). But for most people, the doctor will offer regular checks of the lymph nodes using an ultrasound. You will have an ultrasound every 4 to 6 months for 5 years to look for cancer.
Reconstructive surgery may be done if a large area of skin has been removed when the doctor 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 for locoregional melanoma skin cancer. It is used after surgery to lower the risk of the cancer coming back (recurring). Immunotherapy drugs that may be used include:
- interferon alfa-2b (Intron A)
- nivolumab (Opdivo)
- pembroluzimab (Keytruda)
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Radiation therapy may be offered after surgery for certain cases of locoregional melanoma skin cancer. It is used to lower the 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
- the melanoma skin cancer is on the head or neck, especially when it is mucosal melanoma
Radiation therapy may also be used to control symptoms and the growth of melanoma skin cancer when surgery can’t be done (called unresectable stage 3 melanoma skin cancer).
External beam radiation therapy is aimed at the area of skin where the cancer and lymph nodes were removed (or aimed at the areas with cancer when surgery is not done). It is usually given daily for several weeks.
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Targeted therapy may be offered for locoregional melanoma skin cancer in people who have a BRAF V600E or BRAF V600K gene mutation. Targeted therapy is used to help shrink and control the growth of the melanoma skin cancer.
Trametinib (Mekinist) combined with dabrafenib (Tafinlar) can be used after surgery to treat melanoma skin cancer that has spread to nearby lymph nodes. These drugs are taken as a pill by mouth (orally) daily for 1 year.
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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.
Cancer Care Ontario. Evidence-Based Series 8-6: Surgical Management of Patients with Lymph Node Metastases from Cutaneous Melanoma of the Trunk or Extremities. Version 2 ed. 2018.
Drugs and Health Products, Health Canada. Regulatory Decision Summary: Mekinist. 2018: https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?linkID=RDS00435.
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.