Talking With Your Doctor About Melanoma Treatment
If you have melanoma, you probably have questions about treatment. Finding out about the stage of your melanoma is a good place to start. The stage of your cancer will determine the best treatment options for you.
The stage of your cancer depends on how deep and thick your melanoma is. Whether it has spread to other areas of your body also affects the stage. Stages of melanoma can range from 0 to 4. Stage 0 means melanoma is in only the most superficial layer of your skin. Stage 3 or higher means the melanoma has spread to a lymph node near your cancer or to a distant body site. Once you know the stage of your cancer, you can ask more specific questions about treatments.
Excision—or surgical removal—is the most common treatment for stages 0, 1 and 2 melanomas. Here are some basic treatment options to discuss with your doctor:
Stage 0. The usual treatment is surgical excision. The doctor will removethe cancer along with about half a centimeter of normal skin from around the edges of the cancer. Ask your doctor whether it's possible to do this in the office.
Stages 1 and 2. Surgical excision of the cancer with removal of up to two centimeters of normal tissue is the usual treatment.
Sentinel node biopsy. For some stage 1 and 2 melanomas, doctors advise taking a piece of tissue from a lymph node close to the cancer. This lets them check to make sure the cancer has not spread. If melanoma spreads, it usually affects these lymph nodes first.
Mohs surgery. You may have this type of surgery if you have melanoma in a sensitive area, like your face. It's a good way to avoid removing too much skin. During Mohs surgery, the doctor removes a layer of skin or tissue from around the cancer and then checks it under a microscope. If the tissue includes cancerous cells, the doctor removes another layer and then checks it. Surgery stops when no cancer cells are visible under the microscope.
Your melanoma is stage 3 or 4 if it has spread to lymph nodes or beyond. If that's the case, ask your doctor about these treatment options:
Surgery and lymph node removal. For stage 3 melanoma, you may need surgery to remove the cancer along with the lymph nodes close to the cancer. Be sure to ask your doctor what the surgery will involve. Also ask what your recovery will be like. Besides surgery, you may benefit from treatment to keep melanoma from coming back. Ask whether radiation or chemotherapy might be right for you.
Interferon treatment. Ask your doctor about treatment with interferons. These are synthetic proteins that may strengthen your body’s defenses against cancer. Interferons are given by injections, and they do have some side effects. Discuss the risks and benefits with your doctor.
Immunotherapy and targeted therapy. There are lots of options when it comes to stage 4 melanoma. Your doctor may recommend surgery, radiation treatments, and chemotherapy. Doctors also use immunotherapy and targeted therapy more often for stage 4 melanoma. Immunotherapy uses drugs that help your body’s defense system fight cancer cells. Targeted therapy may involve gene testing to find out which of these drugs might work best for you.
- Clinical trials. Many of the latest treatments for advanced-stage melanoma are available only in clinical trials. Participating in a clinical trial is a good way to advance research while getting the latest treatments from the most experienced doctors. Ask your doctor whether a clinical trial could be a good fit for you.
Research published in the Journal of the American Academy of Dermatology in 2012 followed 33,384 people after treatment for stages 1 to 3 melanoma. Almost 80% still had no sign of cancer after 10 years. If melanoma is stage 1 or 2, it is almost always curable. So take some time to talk with your doctor about what happens after treatment:
Most doctors recommend having a checkup every 3 to 6 months for a few years. Ask your doctor how often you should have a checkup.
You will need to check your skin about once a month to look for any new melanomas or a recurrence of your treated melanoma. Make sure you know what to look for and how to do a good self-exam.
Once you've had melanoma, you are at higher risk for developing other skin cancers. That makes it very important to protect your skin from the sun. Always avoid tanning beds or booths. Ask your doctor to recommend a good sunscreen and make sure to use it every time you're in the sun.