Your melanoma is harder to treat when it spreads to other parts of your body. But you and your doctor still have options to talk about, such as surgery, radiation, chemotherapy, or other types of prescription drugs.
Each person is different, and your team will tailor your care to fit your situation. This will include how far the cancer has spread, where it is in your body, and how healthy you are.
Your doctor will tell you about all your options. Ask what they recommend for you and why, and about the benefits and side effects of each one. Together, you can choose the plan that will be best for you.
Sometimes it helps to see another doctor. Getting a second opinion can help confirm you've made the right treatment choice.
A good first step is to get to know what's involved with each of these approaches. Once you get started, tell your doctor about any side effects or concerns you have.
If your tumor is small, you may be able to go home on the day of your surgery. For larger tumors, you might have to stay in the hospital overnight.
You'll get pain-relieving medicine during the procedure, so you won't feel anything. You may also be "asleep" during it. The doctor will cut out the tumor plus a small area of normal skin around it. Lymph nodes near the tumor will also be removed if cancer cells may have spread there.
The surgeon will stitch up the opening. You'll have a scar. If the wound is big, the surgeon can take a piece of skin from another part of your body to cover it. This procedure is called a skin graft.
Your team will check to make sure all the cancer cells came out. If any remain, you may get chemotherapy or other therapy to kill them.
"Chemo" drugs kill cancer cells. Some people get it to treat cancer that has spread, because it can reach all over the body.
Although chemo won't cure melanoma, it can relieve symptoms and it may help you live longer. It sometimes works better when you also take immunotherapy drugs.
There are many different kinds of chemo drugs. You get them through a vein or take them as a pill by mouth.
If your cancer is only in your arm or leg, you may get chemotherapy in just that limb. Doctors call this treatment "isolated limb perfusion."
You'll get chemotherapy in cycles. Between treatments you'll have a chance to rest and let your body recover. Each cycle lasts for a few weeks. You may also get other types of treatment, such as radiation, at the same time.
Chemo kills all kinds of fast-dividing cells, not just cancer cells. So it can cause side effects such as:
- Hair loss
- Appetite loss
- Nausea and vomiting
- Greater chance of infection
- Mouth sores
- Bruising or bleeding
These problems should stop once you're done with chemo.
This uses high-energy X-rays to kill cancer cells left behind after surgery. It also can ease pain from melanoma that has spread to the brain or bones.
After radiation, you might have:
These side effects should go away once you stop radiation.
Drugs That Target the Cancer
"Targeted therapies" shrink melanoma cells without harming healthy cells. Some target a gene change called "BRAF" that makes melanomas grow. Your doctor may call these drugs "BRAF inhibitors." They shrink tumors and help some people live longer.
Side effects include:
Some people who are treated with these medicines later get another, but less serious type of skin cancer. Your doctor will check your skin for signs of cancer during and after your treatment.
Another type of targeted therapy, called "MEK inhibitors," can thwart melanoma. You may take these as a pill. Side effects include:
Some people take both MEK and BRAF inhibitors.
Drugs That Work on Your Immune System
These medicines use your body's immune system to kill cancer cells. These drugs, which your doctor may call "immunotherapy," fall into two categories:
- Checkpoint inhibitors: These medications help your immune system do a better job of attacking cancer cells. You would get these drugs through a vein once every 2 or 3 weeks. Side effects include:
Cytokines: These boost the immune system as it fights cancer. They can shrink melanoma. You get these drugs through a vein. Side effects include:
- Fluid buildup in the body
Cytokines aren't used very often today because checkpoint inhibitors are safer and work better.
Some doctors combine chemo with one or more immunotherapy drugs, such as the cytokines known as interferon-alpha and interleukin-2. It can help some people feel better because it may shrink tumors. There's not enough evidence to show that it helps you live longer.
Biochemotherapy can have side effects, including:
- Low blood cell count
The FDA hasn't approved it to treat melanoma, but your doctor might recommend it for early stage melanomas that have only spread in the top layers of skin. Sometimes it's combined with other immune treatments. Researchers are checking to see if this therapy will help people with stage IV melanoma.
Side effects of imiquimod include:
- Red, swollen skin where you used the cream
- Flu-like symptoms