Skip to content
My WebMD Sign In, Sign Up

Melanoma/Skin Cancer Health Center

Font Size

Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview

Melanomas that have not spread beyond the site at which they developed are highly curable. Most of these are thin lesions that have not invaded beyond the papillary dermis (Clark level I–II; Breslow thickness ≤1 mm). The treatment of localized melanoma is surgical excision with margins proportional to the microstage of the primary lesion; for most lesions 2 mm or less in thickness, this means 1 cm radial re-excision margins.[1,2]

Melanomas with a Breslow thickness of 2 mm or more are still curable in a significant proportion of patients, but the risk of lymph node and/or systemic metastasis increases with increasing thickness of the primary lesion. The local treatment for these melanomas is surgical excision with margins based on Breslow thickness and anatomic location. For most melanomas more than 2 mm to 4 mm in thickness, this means 2 cm to 3 cm radial excision margins. These patients should also be considered for sentinel lymph node biopsy followed by complete lymph node dissection if the sentinel node(s) are microscopically or macroscopically positive. Sentinel node biopsy should be performed prior to wide excision of the primary melanoma to ensure accurate lymphatic mapping. Patients with melanomas that have a Breslow thickness more than 4 mm should be considered for adjuvant therapy.

Recommended Related to Melanoma/Skin Cancer

Fashion Designer Marc Jacobs Launches Melanoma T-Shirt Campaign

Victoria Beckham did it. So did Heidi Klum, Julianne Moore, Eva Mendes, and Rufus Wainwright. To help raise money for skin cancer, these A-listers let themselves be photographed, naked, for fashion designer Marc Jacobs’ “Protect the Skin You’re In” melanoma naked T-shirt campaign. The celeb photos are featured on the T-shirts, which may be part of the reason why the initiative has so far brought in more than $500,000 for the NYU School of Medicine Interdisciplinary Melanoma Cooperative Group...

Read the Fashion Designer Marc Jacobs Launches Melanoma T-Shirt Campaign article > >

Some melanomas that have spread to regional lymph nodes may be curable with wide local excision of the primary tumor and removal of the involved regional lymph nodes.[3,4,5,6] A completed, multicenter, phase III randomized trial (SWOG-8593) of patients with high-risk primary limb melanoma did not show a benefit from isolated limb perfusion with melphalan in regard to disease-free survival (DFS) or overall survival (OS) when compared to surgery alone.[7] Systemic treatment with high dose and pegylated interferon alpha-2b are approved for the adjuvant treatment of patients who have undergone a complete surgical resection but are considered to be at high risk for relapse. Prospective, randomized, controlled trials with both agents have shown an increase in relapse-free survival (RFS) but not OS when compared with observation.[8] Clinicians should be aware that high-dose and pegylated interferon regimens have substantial side effects, and patients should be monitored closely. Adjuvant therapy with lower doses of interferon have not been consistently shown to have an impact on either RFS or OS.[9]

Although melanoma that has spread to distant sites is rarely curable, both ipilimumab and vemurafenib have demonstrated an improvement in progression-free survival (PFS) and OS in international, multicenter, randomized trials in patients with unresectable or advanced disease, resulting in U.S. Food and Drug Administration (FDA) approval in 2011. Vemurafenib is a selective BRAF V600E kinase inhibitor, and its indication is limited to patients with a demonstrated BRAF V600E mutation by an FDA-approved test.

1|2

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Woman checking out tan lines
SLIDESHOW
Cancer Fighting Foods Slideshow
SLIDESHOW
 
what is your cancer risk
HEALTH CHECK
Could Caffeine Help Fight Skin Cancer
VIDEO
 

12 Ways to Protect Your Skin from Melanoma
ARTICLE
precancerous lesions slideshow
SLIDESHOW
 
Do You Know Your Melanoma ABCs
VIDEO
15 Cancer Symptoms Men Ignore
ARTICLE
 

screening tests for men
SLIDESHOW
Vitamin D
SLIDESHOW
 
Is That Mole Skin Cancer
VIDEO
Brilliant sun rays
Quiz
 

WebMD Special Sections