People with melanoma may be treated with a combination of surgery, chemotherapy, biological therapy, or radiation therapy.

Surgery

Surgery is the usual treatment for melanoma. The surgeon removes the tumor and some normal tissue around it. This procedure reduces the chance that cancer cells will be left in the area. The width and depth of surrounding skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin.

Most melanomas are stage I and can be treated with local excision only if <1mm without ulceration.

More advanced stage II melanomas are treated with surgery, wide local excision, with or without skin graft, and Sentinel Lymph Node Biopsy to see if there is involvement of lymph nodes.

Stage III requires lymph node dissection and consideration of systemic therapy to prevent recurrent or spread of melanoma. In the past, adjuvant therapy for stage III melanoma usually consisted of Interferon. However at California Pacific Medical Center, we now have available a clinical trial of a monoclonal antibody that stimulates the immune system called Ipilumimab.

For Stage IV, chemotherapy with DTIC use to be considered the standard therapy. We now encourage patients to participate in clinical trials of new agents or immune based therapy termed biochemotherapy.

IL2 – Biochemotherapy

Biochemotherapy is an intensive drug treatment regime that combines three chemotherapy drugs, Cisplatin, Velban (Vinblastine), Temodar (Temozolamide), with two active biological agents, interleukin 2 (IL-2) and interferon. Biochemotherapy is used on select patients with metastatic cancer. During biochemotherapy sessions, patients are admitted to the hospital and over four days receive intensive treatment with these five different drugs. This cycle is repeated six times at three-week intervals, after which patients are admitted for two-day treatments once a month for the next one to two years. The treatments can be unpleasant and physically incapacitating, with side effects ranging from nausea and vomiting to systemic inflammatory response, inflaming the patient’s entire body including joints and vital organs.

Recent review of 135 patients treated at California Pacific Medical Center with biochemotherapy show a 5 year survival of 25% who are alive and cancer free. This is higher than with chemotherapy alone.