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Treatment
Once the diagnosis of malignant melanoma
has been confirmed, the tumor is staged to determine prognosis and treatment.
The staging is based on the tumors thickness, and whether there is ulceration,
nodal disease or distant metastases.
For newly diagnosed cutaneous melanoma, a wide surgical excision is typically
used. Regional lymph node removal may also be recommended but the efficacy
of this procedure remains controversial. (Some studies demonstrate a survival
benefit and some studies do not.) For patients who do not have metastases,
but who are at high risk for metastases, adjuvant interferon alpha (2a
or 2b) may be capable of improving disease-free and overall survival in
some patients. However, this treatment has been associated with severe
toxicity.
Melanomas may spread by the lymph system or the bloodstream.
Liver, lung, bone and brain are common sites of metastases. Metastatic
melanoma is generally incurable but a number of new approaches are being
studied in patients. The Cancer Monthly database currently has the results
(survival, side effects, etc.) for 20 recent therapies for melanoma
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Source: Katarina G. Chiller, et al., Cancer of the Skin, in HARRISON'S
PRINCIPLES OF INTERNAL MEDICINE, pt. 5 § 73, at 497-502 (Dennis
L. Kasper, M.D. et al., eds, 16th ed 2005).
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The incidence of melanomas has increased 300% in the
past 40 years. Melanomas affect approximately 54,000 people in the U.S.
and result in over 8,000 deaths each year. Individuals who are most susceptible
to this tumor are those with fair complexions, red or blond hair, blue
eyes, and freckles, and who tan poorly and sunburn easily.