What to Expect From Metastatic Melanoma Treatment

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 she recommends 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.

Surgery

An operation works best for melanoma that has spread to only a few places. Removing the tumors won't cure the cancer, but it can relieve pain and help you live longer.

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.

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Chemotherapy

"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:

These problems should stop once you're done with chemo.

Radiation

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.

One type, called radiosurgery, treats melanoma that has spread to the brain. It aims the radiation right at the tumor to avoid damaging healthy brain cells around it.

After radiation, you might have:

These side effects should go away once you stop radiation.

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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:

  • Rash
  • Diarrhea
  • Swelling

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:

In rare cases, these drugs cause the immune system to attack the lungs, liver, kidneys, or other organs. Make sure to tell your doctor if you have any side effects.

  • Cytokines: These boost the immune system as it fights cancer. They can shrink melanoma. You get these drugs through a vein. Side effects include:
    • Fever
    • Chills
    • Aches
    • Tiredness
    • Fluid buildup in the body

Cytokines aren't used very often today because checkpoint inhibitors are safer and work better.

Biochemotherapy

Some doctors combine chemo with one or more immununotherapy 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:

  • Nausea
  • Vomiting
  • Fever
  • Tiredness
  • Low blood cell count

Topical Creams

"Topical" creams are medicines that you put on your skin. Imiquimod (Zyclara, Aldara) is one that treats some types of skin cancer. It helps the immune system attack cancer cells.

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
  • Crusting
  • Sores
  • Flu-like symptoms
WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on November 14, 2018

Sources

SOURCES:

American Academy of Dermatology: "Imiquimod: FAQS," "Imiquimod: Overview."

American Cancer Society: "Chemotherapy for melanoma skin cancer," "How is melanoma skin cancer treated?" "Immunotherapy for melanoma skin cancer," "Radiation therapy for melanoma skin cancer," "Surgery for melanoma skin cancer," "Targeted therapy for melanoma skin cancer," "Treatment of Melanoma Skin Cancer by Stage."

Japanese Journal of Clinical Oncology: "Complex Combination Biochemotherapy Regimen in Advanced Metastatic Melanoma in a Non-intensive Care Unit: Toxicity or Benefit?"

Cutis: "Topical Imiquimod Clears Melanoma."

Cancer Journal: "Surgery for Distant Melanoma Metastasis."

MD Anderson Cancer Center: "Melanoma Treatment."

National Cancer Institute: "Melanoma Treatment (PDQ)."

Journal of the American Academy of Dermatology: "100% Complete response rate in patients with cutaneous metastatic melanoma treated with intralesional interleukin (IL)-2, imiquimod, and topical retinoid combination therapy: Results of a case series."

Cochrane: "Interventions for treatment of melanoma in situ, including lentigo maligna."

UpToDate: "Patient information: Melanoma treatment; advanced or metastatic melanoma (Beyond the Basics)."

ClinicalTrials.gov: "Imiquimod and Pembrolizumab in Treating Patients With Stage IIIB-IV Melanoma."

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