Treatment

When a melanoma is first removed, it will be examined by a pathologist to check how deeply the melanoma has gone into the skin.

If you have any questions about your treatment don’t be afraid to ask your doctor or the nurses looking after you. It often helps to make a list of questions for your doctor and to take a close friend or relative to the discussion with you.

Stage 1 melanoma

The thinner the melanoma, the better the chance of a complete cure. Melanomas of less than 1mm are not likely to have spread to the lymph nodes or to other parts of the body. They have a very good chance of cure. Most people who are diagnosed with malignant melanoma in the UK will have a thickness of less than 1mm. This is classed as early-stage melanoma. In this situation the complete removal of the melanoma is likely to cure it.

Further tests or treatment will not usually be necessary because the chance of the melanoma coming back is so small. However, your specialist will monitor you carefully for a few years.

Stage 2 melanoma

If the melanoma is thicker than 1mm, it will need to be removed by wide local excision and you may need to have a skin graft (see page 18). Your surgeon may recommend that during the surgery you have a test to see if the melanoma cells have spread to the lymph nodes. The test, known as sentinel lymph node biopsy, is described on page 19.

If melanoma cells are found in the lymph nodes your surgeon may recommend that all the lymph nodes in the area are removed. This is known as a block dissection.

If the melanoma has gone into the deeper layers of skin and there is a strong possibility that it may spread, your doctor may recommend that you have treatment with interferon to try to reduce the chance of the cancer coming back.

Stage 3 melanoma

If the melanoma has spread to the lymph nodes close to the melanoma, your surgeon may recommend that all the lymph nodes in the area are removed as well as removing the melanoma itself. You may also have some further tests to check if the cancer has spread to any other part of the body.

You may be offered treatment with biological therapies, chemotherapy or a combination of these.

Stage 4 melanoma

If the melanoma has spread to other parts of the body, surgery may be used to remove the melanoma cells in the skin or lymph nodes. Treatment cannot generally cure the melanoma in this situation, but it may control the growth of the melanoma cells for some time. The length of time may range from a few months to longer. Treatments that may help, include biological therapies, chemotherapy, radiotherapy, or a combination of these.

Recurrent melanoma

If a melanoma has spread or come back, surgery may be used to remove the melanoma cells from the skin or lymph nodes. If the melanoma has spread to other areas of the body, interferon, chemotherapy or radiotherapy may also be used. Research is going on all the time to find the best ways of giving the current treatments and to find new types of treatment.

Laser treatment may be used to treat melanoma which has come back in the skin. If a melanoma comes back in an arm or leg, a treatment known as isolated limb perfusion may be used.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you. You will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• l the type and extent of the treatment you are advised to have
• l the advantages and disadvantages of the treatment
• l any possible alternative treatments that may be available
• l any significant risks or side effects of the treatment

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to know how the treatment is likely to affect you, and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t decide when it is first explained to you.

You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it. If you decide not to have the treatment, it is essential to tell a doctor, or the nurse in charge, immediately so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

The benefits and disadvantages of treatment

Many people are frightened at the idea of having treatment for cancer, because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

In people with early-stage melanoma, surgery has a very high chance of completely curing the cancer. The surgery will leave a scar on the skin. However, if the surgery is not done the melanoma is likely to spread into the deeper layers of the skin and then to other areas of the body.

If the melanoma has spread to other parts of the body, treatment cannot cure it, but may be able to control it for a time. This can lead to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit. Although treatments can cause side effects, these can usually be controlled.

If you have been offered surgery to cure your melanoma, deciding whether to accept the treatment may not be difficult. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss the treatment options in detail with your doctor.