Your doctor will recommend the type of skin cancer treatment you need depending on your stage, location and the extent of the melanoma. According to experts Sundoctors Australia “ Other factors, like the likelihood of cancer returning, the gene changes in the cancer cells, or your overall health, can also be important”.
Treating stage 0 melanoma
The epidermis is the top layer of skin that has not been affected by Stage 0 melanoma. The surgery (wide-excision) is used to remove the melanoma along with a small amount of normal skin. The sample is sent to a laboratory to be examined under a microscope. A second, larger excision may be performed if cancer cells are detected around the edges.
While some doctors might recommend the use of radiation therapy or imiquimod cream (Zyclara), others may not agree.
Some doctors might use Mohs Surgery, or even imiquimod cream, to treat melanomas that are located in sensitive areas of the face. However, not all doctors agree.
Treating stage I melanoma
Stage I melanoma can be treated with wide excision ( operation) to remove the melanoma and leave a margin of normal, healthy skin. The thickness and location of the melanomas determine the width of the margin. Most of the time, there is no need for any other treatment.
A sentinel Lymph Node Biopsy may be recommended by some doctors to check for signs of cancer in nearby lymph nodes. This is especially important if the melanoma has advanced to stage IB, or if there are other factors that increase its likelihood of spreading. This option should be discussed with your doctor.
Treating stage II melanoma
Wide excision ( Surgery to remove the melanomas and leave a margin of normal skin) is the best treatment for stage II melanoma. The thickness and location of the melanoma affect the width of the margin.
A SLNB can be performed and it does not reveal cancer cells in the lymph nodes. However, close follow up is important.
To reduce the chance of cancer returning, certain stage II melanomas might be treated with the immune-checkpoint inhibitor pembrolizumab (Keytruda).
If the SLNB determines that the sentinel nude is containing cancer cells, then a lymph node dissection (where all lymph nodes in the area are removed surgically) may be performed. To lower the chances of melanoma returning, it might be a good idea to have an adjuvant (supplementary) treatment with immuno checkpoint inhibitors and targeted therapies drugs. As part of a clinical study, other drugs and vaccines may also be available.
Treating stage III melanoma
When melanoma first appears, these cancers already have reached the lymph nodes. Stage III melanoma surgery usually involves wide excisions of the primary tumor, as in earlier stages.
Adjuvant treatment with immune checkpoint inhibitors and targeted therapy drugs may be recommended after surgery to reduce the chance of melanoma returning. To reduce the likelihood of melanoma returning, other drugs and vaccines may be recommended in a clinical study. You can also give radiation therapy in the areas where lymph nodes have been removed. This is especially important if there are many nodes that contain cancer.
Stage III melanoma may not be curable with current treatments. They might consider participating in a clinical study to test newer treatments.
The 4th stage melanoma treatment
Stage IV melanomas are already spreading (metastasized to distant lymph nodes and other parts of the body). Surgery can sometimes be used to remove skin tumors and enlarged lymph nodes that cause symptoms. Radiation Therapy is also available.
Depending on the number of metastases and their likelihood to cause symptoms, they may be removed. Radiation, immunotherapy and targeted therapy can be used to treat metastases that are not able to be removed.
Recent advances in immunotherapy and targeted drugs have made it possible to treat widespread melanomas. They are more effective than chemotherapy.