Melanoma treatment has largely been surgical because
in the past chemotherapy has not been effective. The primary treatment requires local surgical
excision of the tumor with a margin of normal tissue. This margin varies somewhat with the
thickness of the primary tumor. The
primary tumor should be excised whenever possible. In cases of large tumors, an incisional biopsy
can be obtained for planning further treatment.
In determining further treatment, two things need to be determined from
the biopsy, the Clark Level and the Breslow thickness. These two factors are used with anatomic site
of the tumor to determine the next step, sentinel node biopsy.
Sentinel lymph node biopsy is a process where the
first lymph node to which a tumor might spread is determined and removed for
study. In some cases there maybe more than one that is identified and therefore
both are removed. If the tumor has not
spread to this lymph node it is unlikely to have spread to other lymph nodes, a
crucial bit of information in determining further treatment. If the sentinel lymph node has tumor in it,
a regional lymph node dissection may be done.
This is a procedure where a large collection of lymph node are
removed. Lymph node dissection may not
affect survival in very thin or very thick tumors but may be helpful in
intermediate tumors.
Melanoma is largely treated surgically. Radiation therapy has not been helpful for
primary tumors but may have some benefits in palliation of metastatic
disease. Chemotherapy has also not been
helpful for primary melanoma, again used largely in a palliative role. The recent advances in immunomodulators has
shown some promise. Interferon therapy
has shown some benefit in Stage III melanoma, and may have its indication
extends by further studies. The last frontier in treatment is immunotherapy or
a melanoma vaccine. Currently the work
on this is ongoing but early result do show some benefits in some cases. As in all cases, the details of your care should be discussed with your physician.
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