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Posted by on Oct 29, 2019 in Melanoma | 0 comments

In a nutshell

This article reviewed different treatment options for patients with melanoma.

Some background

Melanoma is one of the most common cancers worldwide. Treatment options for patients with melanoma depend on how extensive it is. Melanoma that remains in its original site in the skin is called localized disease. It can also spread to lymph nodes and sites close to the original tumor, which is called locoregional disease. Cancer that has spread to other sites in the body is called metastatic or advanced disease.

Methods & findings

For patients with localized disease, surgery to remove the tumor is recommended. In addition to the tumor, an extra 0.5 cm of surrounding tissue called a margin should also be removed. This is usually done to prevent cancer recurrence. For larger tumors, this margin may be increased to 1 or 2 cm. 

For patients with disease that has not spread outside of the lymph nodes, completely removing the affected lymph nodes with surgery is recommended to prevent it from spreading. For patients with cancer that has spread outside of the lymph nodes, surgery is not recommended. These patients may benefit from other treatments.

For patients with stage 3 melanoma that is still in the lymph nodes, anti-cancer therapy is recommended. Radiation therapy is recommended for patients with melanoma on the skin. Radiation is also used to eliminate any residual cancer after surgery, especially for tumors larger than 5 cm. Biological therapy with or without targeted therapy is also an option. Combining these treatments may help boost the body's immune system attack the cancer cells.

For patients with advanced (stage 3 or higher) melanoma or melanoma that has spread, surgery or radiation therapy are both recommended. Biological therapy using nivolumab or pembrolizumab combined with ipilimumab (Yervoy) are additional options. For patients with a genetic mutation called BRAF, targeted therapy regimens are recommended.

For patients with stage II metastatic/advanced melanoma, chemotherapy may be recommended. Some patients may not respond to chemotherapy; for these patients, clinical trials can be promising. For patients with cancer that has spread to the brain, targeted therapy is often recommended as a first-line treatment. A type of radiation therapy called stereotactic radiosurgery can be the next step for patients who do not respond to first-line treatment.

The bottom line

This article reviewed different treatment options for patients with melanoma based on disease type and stage. Surgery and radiation therapy are recommended for localized disease while biological and targeted therapies are recommended for advanced disease.

Published By :

Annals of oncology: official journal of the European Society for Medical Oncology

Date :

Sep 30, 2019

Original Title :

Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

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