About melanoma - Treatment
Most melanomas are treated simply by surgical excision. A small amount (5 to 10mm) of normal skin around the melanoma is also removed to ensure that all melanoma cells are removed. This is usually done under local anesthetic.
Some people with deep melanomas (deeper than 1mm) may be offered a new technique called sentinel node biopsy. This technique involves determining the lymph node or nodes which receive lymph drainage directly from the melanoma. The lymph node is visualised by injecting a small amount of radioactive material around the site of the primary melanoma and marking the site of the “hot” node with an indelible skin mark. At the time of surgery, the surgeon injects a blue dye at the site of the primary melanoma and this stains the lymph node blue. When the surgeon makes a small cut over the marked lymph node he is able to find the appropriate lymph node because it is blue in color and contains the radioactivity which is detected by a specialised probe. The lymph node is then sent to pathology and if it contains melanoma cells all the lymph nodes in that field are removed.
It is important to note that removal of the sentinel lymph node and the following major lymph node removal does not change the chances of survival of the person with melanoma. Sentinel node biopsy is essentially a staging procedure, ie it enables a more accurate estimate of the risk of the melanoma spreading into the body. An additional benefit of sentinel node biopsy is for selection of those people who may benefit by entry into clinical trials of new treatments.
Melanoma will spread to the lymph nodes in a small number of people, and very rarely, melanoma can occur in the lymph nodes without a melanoma being present on the skin. The treatment for these secondary tumors (metastasis) is surgical removal of all the lymph nodes in that area. This operation is known as lymph node dissection.
For those people who are unfortunate enough to have the melanoma spread into the bloodstream the treatment depends on where the secondary tumors are located. Sometimes these tumors can be removed surgically but it is more common for the person to be treated with anticancer agents (chemotherapy). Because standard chemotherapy for melanoma is not highly effective most people are treated firstly with new anticancer agents as part of clinical trials.