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Melanoma

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Treatment of stage III melanoma

The following are treatment options for stage III melanoma. The types of treatments given are based on the unique needs of the person with cancer.

Surgery

Surgery is the primary treatment for stage III melanoma. The types of surgery are:

  • sentinel lymph node biopsy (SLNB)
    • Preferably, SLNB is done at the same time as wide excision.
    • If the SLNB is positive, all of the lymph nodes in the area may be removed.
  • wide excision
    • Wide excision is used to remove the tumour along with a margin of healthy tissue. The size of the margin will depend on the thickness of the tumour and its location.
    • Surgery may be used to remove in-transit metastatic disease or metastasis to the skin or lymph nodes.
    • If the disease is unresectable (cannot be removed with surgery), treatment with isolated limb perfusion or infusion may be considered.
  • skin reconstruction
    • Skin reconstruction may be necessary depending on the amount of tissue removed.
  • lymph node removal
    • Enlarged lymph nodes are removed with lymph node dissection.

Biological therapy

Biological therapy may be offered after surgery (adjuvant therapy) for stage III melanomas that have been completely removed with surgery to reduce the risk of recurrence. The most common biological therapy used is high-dose interferon alfa-2b (Intron A). It is given by intravenous (IV)intravenous (IV)Within or into a vein (a blood vessel that carries blood from tissues and organs in the body to the heart). infusion and subcutaneous (SC)subcutaneous (SC)Beneath or just under the skin. injection.

Biological therapy may also be used to treat melanoma that cannot be removed with surgery (unresectable). The most common types of biological therapy used include:

  • ipilimumab (Yervoy)
    • Ipilimumab is a monoclonal antibody used to treat advanced melanoma. It is given by intravenous (IV) infusion.
  • interleukin-2 (Aldesleukin, Proleukin)
    • This drug may be used locally to treat in-transit metastases on an arm or a leg.
    • Interleukin-2 is injected into individual lesions. This method has fewer side effects than regional chemotherapy and does not need to be done in a specialized centre.
  • intralesional Bacillus Calmette-Guérin (BCG)
    • This drug may be used for local or regional metastasis as it is less toxic than systemic therapies.
    • BCG is injected right into the lesion.

Radiation therapy

Following surgery to remove lymph nodes, people with a high risk of lymph node recurrence may be given adjuvant high-dose radiation therapy to the area where the lymph nodes were removed. This includes people with:

  • microscopic evidence of extension of the cancer outside of the lymph node
  • microscopic evidence of residual disease in lymph nodes
  • extensive nodal disease (where complete resection is not likely)
  • bulky nodal disease (enlarged lymph nodes) greater than 3 cm in diameter that was completely removed
  • 3 or more positive lymph nodes

Regional chemotherapy

Regional chemotherapy may be used to treat people with local nodal metastases, in-transit metastases or multiple recurrences on an arm or leg that cannot be completely removed with surgery. The chemotherapy drug most commonly used for regional chemotherapy is melphalan (Alkeran, L-PAM).

Regional chemotherapy may involve:

  • isolated limb perfusion
  • isolated limb infusion

Targeted therapy

Targeted therapy may be offered to people with unresectable metastatic melanoma. These drugs are given by mouth. The targeted chemotherapy drugs used to treat advanced or metastatic melanoma are:

  • vemurafenib (Zelboraf)
  • dabrafenib (Tafinlar)
  • trametinib (Mekinist)
  • prembolizumab (Keytruda)

Clinical trials

People with melanoma may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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