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Four Stage Treatment of Melanoma
Posted on Sunday, June 19, 2011 by Choirul Ichsan
The kind of treatment(s) your physician suggests will rely on happens and placement from the melanoma as well as on your general health. This lists the choices usually considered for every stage of melanoma.
Stage
Stage melanomas haven't grown much deeper compared to epidermis. They're usually treated by surgery to get rid of the melanoma along with a margin around 1/2 centimetres (about 1/5 inch) of normal skin. For melanomas in sensitive areas about the face, some doctors could use a cream that contains the drug imiquimod (Aldara) if surgery may be disfiguring, while not all doctors accept this use.
Stage I
Stage I melanoma is treated by surgery to get rid of the melanoma in addition to a margin of normal skin. The quantity of normal skin removed is dependent about the thickness from the melanoma. Once the thickness is under 1 mm, wide excision with 1 centimetres (2/5 inch) margins is suggested. For stage I melanomas between 1 mm and 2 mm thick, the tumor and 1 centimetres to 2 centimetres (4/5 inch) of surrounding skin are removed. A maximum of 2 centimetres of normal skin must be taken off every side of the melanoma in stage I. Wider margins make healing harder and haven't been found to help individuals live longer.
Some doctors may recommend a sentinel lymph node biopsy, particularly if the melanoma is stage IB or has other qualities making it more prone to have spread towards the lymph nodes. It is really an option that both you and your physician should discuss.
When the sentinel lymph node biopsy is positive, a lymph node dissection (elimination of all lymph nodes close to the cancer) is frequently suggested, but it is not obvious whether it can improve survival.
Stage II
Wide excision may be the standard strategy to stage II melanoma. When the melanoma is between 1 mm and 2 mm thick, a margin of 1 to 2 centimetres of normal skin is going to be removed too. When the melanoma is thicker than 2 mm, about 2 centimetres of normal skin is going to be taken off round the tumor site.
Since the melanoma might have spread to lymph nodes close to the melanoma, many doctors recommend a sentinel lymph node biopsy too. It is really an option that both you and your physician should discuss. If it's done and also the sentinel node consists of cancer, a lymph node dissection (where all of the lymph nodes for the reason that area are surgically removed) is going to be done later on.
In some cases (for example when the tumor is discovered to be a lot more than 4 mm thick or if lymph nodes contain cancer), some doctors may advise adjuvant therapy (additional treatment) with interferon after surgery. Other drugs or possibly vaccines can also be suggested included in a medical trial to try and lessen the chance the melanoma will return.
Stage III
These cancer have arrived at the lymph nodes during the time of diagnosis. Surgical procedure for stage III melanoma usually requires lymph node dissection, together with wide excision from the primary tumor as with stage II. Adjuvant therapy with interferon might help some patients with stage III melanomas protect against recurrence longer.
If several melanomas can be found, they ought to be removed. If this isn't possible, injections of bacille Calmette-Guerin (BCG) vaccine or interleukin-2 into the melanoma or using the topical immunotherapy imiquimod are treatments. For melanomas with an branch, another possible choice is to isolated limb perfusion (infusing the limb having a heated solution of chemotherapy). In some instances, radiotherapy might be given being an adjuvant to surgery in the region where lymph nodes were removed, particularly if most of the nodes put together to contain cancer. Other possible remedies include chemotherapy, immunotherapy with cytokines, or both combined (biochemotherapy).
More recent remedies being examined in clinical tests will benefit some patients. Many patients with stage III melanoma might not be healed with current remedies, so that they might want to consider getting involved in a medical trial.
Stage IV
Stage IV melanomas are very difficult to cure, as they have spread to distant lymph nodes or any other parts of the body. Skin growths or lymph node metastases leading to signs and symptoms can frequently be removed by surgery. Metastases in organs are occasionally removed, based on the number of can be found, where they're situated, and just how likely they're to result in signs and symptoms. Metastases that create signs and symptoms but can't be removed surgically might be given radiation, immunotherapy, or chemotherapy.
Ipilimumab (Yervoy), a more recent immunotherapy drug, continues to be proven to assist many people with advanced melanoma live longer. It is only now entering use, however, many doctors may prefer it over other treatments, for example chemotherapy or other kinds of immunotherapy.
The chemotherapy drugs being used at this time around are of limited value in many individuals with stage IV melanoma. Dacarbazine (DTIC) and temozolomide (Temodar) are the type most frequently used, either on their own or coupled with other drugs. Even if chemotherapy can shrink these cancer, the result is frequently temporary, by having an average duration of about 3 to 6 several weeks prior to the cancer begins growing again. In rare cases they work effectively for extended amounts of time, however.
Immunotherapy using interferon or interleukin-2 might help a small amount of patients with stage IV melanoma live longer. Greater doses of those drugs appear to become more efficient, but they likewise have worse unwanted effects.
Some doctors recommend biochemotherapy: a mix of chemotherapy and only interleukin-2, interferon, or both. For instance, some doctors use interferon with temozolomide. The 2 drugs combined cause more tumor shrinkage, which might make patients feel good, even though combination is not proven to assist patients live longer. Another drug combination uses low doses of interferon, interleukin-2, and temozolomide. Each appears to profit some patients. Patients should think about the possible benefits and unwanted effects associated with a suggested treatment before beginning.
Because stage IV melanoma is very difficult to treat with current treatments, patients might want to consider getting involved in a medical trial. Clinical tests of recent chemotherapy drugs, specific drugs, new techniques of immunotherapy for example vaccines, and mixtures of various kinds of remedies will benefit some patients.
Despite the fact that the outlook for patients with stage IV melanoma is commonly poor overall, a small amount of patients have responded perfectly to treatment or have made it for several years after diagnosis.
Recurrent melanoma
Management of melanoma that returns after initial treatment is dependent about the stage from the original melanoma, the last treatment, and also the site of recurrence.
Melanoma may return within the skin close to the site from the original tumor. Generally, these local (skin) repeated episodes are given surgery much like that suggested for any primary melanoma. This might incorporate a sentinel lymph node biopsy. With respect to the thickness and placement from the tumor, other remedies might be considered, for example isolated limb perfusion chemotherapy, systemic chemotherapy, immunotherapy, radiotherapy, or tumor injection with BCG vaccine or interferon.
If nearby lymph nodes were not removed throughout the first treatment, the melanoma may return during these nearby lymph nodes. This might appear like a swelling or tumor mass. Lymph node recurrence is treated by lymph node dissection, and could include adjuvant therapy for example interferon or radiotherapy.
Cancer may also return in distant sites. Just about any organ could be affected. Most frequently, the melanoma will return within the lung, bone, liver, or brain. Strategy to these repeated episodes is usually exactly the same for stage IV melanoma (see above). Melanomas that recur with an branch might be given isolated limb perfusion chemotherapy.
Melanoma that returns within the brain could be tough to treat. Single sites of recurrence can often be removed by surgery. Most chemotherapy drugs can't achieve the mind, although temozolomide might be helpful. Radiotherapy towards the brain might help too.
Stage
Stage melanomas haven't grown much deeper compared to epidermis. They're usually treated by surgery to get rid of the melanoma along with a margin around 1/2 centimetres (about 1/5 inch) of normal skin. For melanomas in sensitive areas about the face, some doctors could use a cream that contains the drug imiquimod (Aldara) if surgery may be disfiguring, while not all doctors accept this use.
Stage I
Stage I melanoma is treated by surgery to get rid of the melanoma in addition to a margin of normal skin. The quantity of normal skin removed is dependent about the thickness from the melanoma. Once the thickness is under 1 mm, wide excision with 1 centimetres (2/5 inch) margins is suggested. For stage I melanomas between 1 mm and 2 mm thick, the tumor and 1 centimetres to 2 centimetres (4/5 inch) of surrounding skin are removed. A maximum of 2 centimetres of normal skin must be taken off every side of the melanoma in stage I. Wider margins make healing harder and haven't been found to help individuals live longer.
Some doctors may recommend a sentinel lymph node biopsy, particularly if the melanoma is stage IB or has other qualities making it more prone to have spread towards the lymph nodes. It is really an option that both you and your physician should discuss.
When the sentinel lymph node biopsy is positive, a lymph node dissection (elimination of all lymph nodes close to the cancer) is frequently suggested, but it is not obvious whether it can improve survival.
Stage II
Wide excision may be the standard strategy to stage II melanoma. When the melanoma is between 1 mm and 2 mm thick, a margin of 1 to 2 centimetres of normal skin is going to be removed too. When the melanoma is thicker than 2 mm, about 2 centimetres of normal skin is going to be taken off round the tumor site.
Since the melanoma might have spread to lymph nodes close to the melanoma, many doctors recommend a sentinel lymph node biopsy too. It is really an option that both you and your physician should discuss. If it's done and also the sentinel node consists of cancer, a lymph node dissection (where all of the lymph nodes for the reason that area are surgically removed) is going to be done later on.
In some cases (for example when the tumor is discovered to be a lot more than 4 mm thick or if lymph nodes contain cancer), some doctors may advise adjuvant therapy (additional treatment) with interferon after surgery. Other drugs or possibly vaccines can also be suggested included in a medical trial to try and lessen the chance the melanoma will return.
Stage III
These cancer have arrived at the lymph nodes during the time of diagnosis. Surgical procedure for stage III melanoma usually requires lymph node dissection, together with wide excision from the primary tumor as with stage II. Adjuvant therapy with interferon might help some patients with stage III melanomas protect against recurrence longer.
If several melanomas can be found, they ought to be removed. If this isn't possible, injections of bacille Calmette-Guerin (BCG) vaccine or interleukin-2 into the melanoma or using the topical immunotherapy imiquimod are treatments. For melanomas with an branch, another possible choice is to isolated limb perfusion (infusing the limb having a heated solution of chemotherapy). In some instances, radiotherapy might be given being an adjuvant to surgery in the region where lymph nodes were removed, particularly if most of the nodes put together to contain cancer. Other possible remedies include chemotherapy, immunotherapy with cytokines, or both combined (biochemotherapy).
More recent remedies being examined in clinical tests will benefit some patients. Many patients with stage III melanoma might not be healed with current remedies, so that they might want to consider getting involved in a medical trial.
Stage IV
Stage IV melanomas are very difficult to cure, as they have spread to distant lymph nodes or any other parts of the body. Skin growths or lymph node metastases leading to signs and symptoms can frequently be removed by surgery. Metastases in organs are occasionally removed, based on the number of can be found, where they're situated, and just how likely they're to result in signs and symptoms. Metastases that create signs and symptoms but can't be removed surgically might be given radiation, immunotherapy, or chemotherapy.
Ipilimumab (Yervoy), a more recent immunotherapy drug, continues to be proven to assist many people with advanced melanoma live longer. It is only now entering use, however, many doctors may prefer it over other treatments, for example chemotherapy or other kinds of immunotherapy.
The chemotherapy drugs being used at this time around are of limited value in many individuals with stage IV melanoma. Dacarbazine (DTIC) and temozolomide (Temodar) are the type most frequently used, either on their own or coupled with other drugs. Even if chemotherapy can shrink these cancer, the result is frequently temporary, by having an average duration of about 3 to 6 several weeks prior to the cancer begins growing again. In rare cases they work effectively for extended amounts of time, however.
Immunotherapy using interferon or interleukin-2 might help a small amount of patients with stage IV melanoma live longer. Greater doses of those drugs appear to become more efficient, but they likewise have worse unwanted effects.
Some doctors recommend biochemotherapy: a mix of chemotherapy and only interleukin-2, interferon, or both. For instance, some doctors use interferon with temozolomide. The 2 drugs combined cause more tumor shrinkage, which might make patients feel good, even though combination is not proven to assist patients live longer. Another drug combination uses low doses of interferon, interleukin-2, and temozolomide. Each appears to profit some patients. Patients should think about the possible benefits and unwanted effects associated with a suggested treatment before beginning.
Because stage IV melanoma is very difficult to treat with current treatments, patients might want to consider getting involved in a medical trial. Clinical tests of recent chemotherapy drugs, specific drugs, new techniques of immunotherapy for example vaccines, and mixtures of various kinds of remedies will benefit some patients.
Despite the fact that the outlook for patients with stage IV melanoma is commonly poor overall, a small amount of patients have responded perfectly to treatment or have made it for several years after diagnosis.
Recurrent melanoma
Management of melanoma that returns after initial treatment is dependent about the stage from the original melanoma, the last treatment, and also the site of recurrence.
Melanoma may return within the skin close to the site from the original tumor. Generally, these local (skin) repeated episodes are given surgery much like that suggested for any primary melanoma. This might incorporate a sentinel lymph node biopsy. With respect to the thickness and placement from the tumor, other remedies might be considered, for example isolated limb perfusion chemotherapy, systemic chemotherapy, immunotherapy, radiotherapy, or tumor injection with BCG vaccine or interferon.
If nearby lymph nodes were not removed throughout the first treatment, the melanoma may return during these nearby lymph nodes. This might appear like a swelling or tumor mass. Lymph node recurrence is treated by lymph node dissection, and could include adjuvant therapy for example interferon or radiotherapy.
Cancer may also return in distant sites. Just about any organ could be affected. Most frequently, the melanoma will return within the lung, bone, liver, or brain. Strategy to these repeated episodes is usually exactly the same for stage IV melanoma (see above). Melanomas that recur with an branch might be given isolated limb perfusion chemotherapy.
Melanoma that returns within the brain could be tough to treat. Single sites of recurrence can often be removed by surgery. Most chemotherapy drugs can't achieve the mind, although temozolomide might be helpful. Radiotherapy towards the brain might help too.
Category Article Treatment of Melanoma
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