Friday, January 18, 2013

Melanoma Treatment

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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