Melanoma

Treatment

Mayo Clinic offers patients the latest treatment options for all forms of melanoma, including ocular melanoma and familial melanoma. The treatment team's goal is to begin melanoma treatment as soon as possible after the diagnosis is made. Melanoma treatment decisions are made by the patient and an experienced team of Mayo doctors representing multiple specialties, who carefully consider the risks and benefits of treatment options.

For patients with early-stage, resectable (removable) melanoma, doctors usually recommend surgery alone or in combination with a sentinel lymph node biopsy.

For individuals with widespread, late-stage melanoma, treatment recommendations vary depending on the patient's condition. Recommendations may include surgery, chemotherapy, radiation therapy or experimental therapies such as immunotherapy. Patients may be offered the opportunity to participate in clinical trials when a new, investigational therapy is appropriate for their medical situation.

Surgery

The standard surgical approach for many types of melanoma is excision – removal of the tumor and a margin of the healthy surrounding tissue. The width of this margin depends on the depth of the melanoma.

The lymph nodes are one of the most common places where tumors spread. A sentinel lymph node biopsy will often be performed to determine if the cancer has spread to the lymph notes.  If tumor cells are found in the sentinel lymph node, then it and other affected lymph nodes will be excised (removed).  In some cases, the biopsy and lymph node removal can be done in the same procedure.

Mohs surgery can be used to treat some melanomas on the skin of the head and neck region.

Mohs surgery is used to treat some melanomas (lentigo maligna) in the head and neck that have not spread to other areas. During this surgery, the surgeon carefully removes cancer tissue layer by layer, minimizing removal of healthy tissue, until the entire tumor has been removed. Each layer of tissue is stained with chemicals (immunohistochemical staining) that help visualize cancer cells, and examined by a Mohs surgeon under a microscope to confirm that all cancer tissue has been removed.

Mohs surgery is offered at all Mayo Clinic locations. Mayo surgeons have extensive expertise and specialized training in performing this form of surgery to treat lentigo maligna.

Radiation therapy

Radiation therapy can be used for certain types of melanoma tumors. Some aggressive melanoma tumors are treated initially with surgery followed by radiation treatment. However, radiation may put the patient at risk for future nonmelanoma skin cancers.

Mayo Clinic surgeons have extensive expertise and experience in using stereotactic radiosurgery to treat certain melanoma cases. During this procedure, high doses of targeted radiation are delivered precisely to the tumor without exposing surrounding healthy tissue to radiation.

Chemotherapy

The Mayo treatment team may recommend chemotherapy prior to and after surgery to ensure that as much tumor tissue as possible is destroyed.

Hyperthermic isolated limb perfusion (HILP) is a unique chemotherapy option for malignant melanoma that is not commonly available at most medical centers. It is often used for tumors in an arm or leg that frequently reoccur but remain confined to that area.

HILP treatment is delivered in the operating room. The affected arm or leg is connected to a heart-lung bypass machine, and chemotherapy is administered through the machine directly to the arm or leg with melanoma. The benefit of this therapy is that high doses of chemotherapy can be delivered directly to the targeted region without exposing the rest of the body to chemotherapy. Melanomas in this area are highly responsive to HILP treatment.

Experimental treatments

Despite significant research efforts, no highly effective treatments currently exist for patients with widespread, late-stage melanoma. Mayo Clinic is a leader in developing and evaluating new melanoma treatment options. Mayo is designated as a comprehensive cancer center by the National Cancer Institute, which increases the opportunities for Mayo patients to enroll in melanoma clinical trials of new therapies.

Some Mayo patients under regular treatment for late-stage disease also choose to receive experimental treatments. Late-stage melanoma treatments currently being studied in clinical trials include vaccines, chemotherapy, radiation therapy, skin creams, tumor injections, drug combinations, tumor-inhibiting chemical agents and cryotherapy (cell freezing). The Mayo treatment team can help determine if a patient qualifies as a trial participant. See clinical trials for more information on current trials.

Immunotherapy

Immunotherapy is one of the most commonly recommended experimental therapies that Mayo patients receive through clinical trials. Immunotherapy boosts the ability of the body's own immune system to seek out and destroy melanoma tumors in the body. Mayo researchers are actively involved in developing and testing immunotherapy treatment options.