Melanoma Treatment
If malignant melanoma is caught in the early stages, surgical removal of the cancerous tumor is the most effective melanoma treatment. A surgeon will remove the entire tumor plus layers of skin under and around it. Removing the surrounding skin will help to ensure that the tumor does not recur in the future. Re-excision surgery is another common procedure for tumor removal. This melanoma treatment follows an excisional biopsy – doctors cut away more skin from the original incision to eradicate all cancerous cells. Another surgery performed to treat melanoma is a lymphadenectomy. After a lymphoscintigraphy has disclosed the location of the sentinel lymph node, every lymph node adjacent to the infected sentinel node is removed. Moh’s micrographic surgery is a rarely used melanoma treatment. This surgery involves the excision of a small layer of tissue that is subsequently frozen and examined. This process is repeated until the excised tissue layer is clear of melanoma cancer. Moh’s micrographic surgery is not often performed as a melanoma treatment because it is difficult to identify melanoma cancer cells on a frozen tissue section.
Surgery is only effective as a melanoma treatment on regional or early-stage melanoma. Metastatic melanoma that has reached other parts of the body requires alternate treatments, such as chemotherapy, radiation therapy, immunotherapy or gene therapy. Often times these melanoma treatments will be used in combination with surgery to prolong or improve the quality of a patient’s life. Unfortunately, once metastasis is deemed distant the melanoma is considered incurable. The five year survival rate of distant metastatic melanoma is less than ten percent with the median survival time set at six to twelve months. Even after this deplorable diagnosis, doctors recommend alternative treatments to make life more bearable for the cancer patient.
Chemotherapy is the use of multiple medications used in combination to kill cancer cells. Medication can be injected or taken in pill form, generally for a period of four to six months. The drugs impair cell division and work most effectively on fast-dividing cells. Chemotherapeutic drugs are rarely prescribed as a melanoma treatment because the results can be unpredictable. Scientists have not learned how to target specific cells; therefore, chemotherapy medications affect all fast-dividing cells causing many unwanted side effects. Hair loss, dry or discolored skin and nails, ulcers of the mouth and digestive tract problems are all side effects of this melanoma treatment. Another downfall of chemotherapeutic drugs is their inability to affect late-stage tumors. As tumors grow they begin to develop a solid core of unmoving cells. Because these drugs work on unstable cells, they prove to be ineffective at reaching the static center and therefore a poor melanoma treatment.
Radiation therapy can be used as a cure or a palliative melanoma treatment. A palliative melanoma treatment is used when a cure cannot be found; it focuses on reducing symptoms and improving quality of life. Radiation therapy uses high-energy x-rays to damage the DNA of cancerous cells. The painless procedure utilizes radiation beams aimed at the tumor from several different angles. The DNA damage is inherited through subsequent cell division and either kills the cancerous cells or causes them to reproduce more slowly. Much like chemotherapy, radiation therapy has its limitations as a late-stage melanoma treatment. As tumors age and solidify the oxygen supply decreases. Radiation therapy needs a steady oxygen supply to make DNA damage permanent; thus, this procedure is most effective in as an early-stage melanoma treatment.
Immunotherapy, also called biological therapy, stimulates the immune system to reject or destroy malignant melanoma tumors. Scientists and doctors have high expectations for the use of this alternative treatment – they believe malignant melanoma is the most vulnerable to immune system responses. There are two types of immunotherapy: active and passive. Active immunotherapy is performed by stimulating one’s own immune system to fight off the disease. Alternatively, passive immunotherapy relies on a man-made component to encourage an immune response. Again, immunotherapy is most effective as an early-stage melanoma treatment. Often it is used in combination with surgery and medication to reduce malignant cancer symptoms.
Gene therapy is another form of alternative malignant melanoma treatment, albeit a controversial one. Genes are inserted into cells to either treat a disease or replace mutant genes with healthy ones. A carrier molecule or vector is needed to transport the healthy gene to the target gene. The most common vector is a virus that has been genetically altered to carry human genetic material. The viral vector is sent to the infected cell where it unloads the genetic material generating a functional protein product and restoring the target gene. At this time gene therapy is entirely experimental – the FDA has not approved the sale of the technique and results have been less than positive in clinical trials as a melanoma treatment. Several problems could arise: multiple rounds of therapy may be required due to the short lifespan of DNA; the immune system may respond to the viral vector as an intruder; viral vectors could cause toxicity, inflammation or never reach the target destination; and it may have no effect on multi-gene disorders. There are also many ethical questions associated with gene therapy at this stage: How will the procedure be regulated? Who will receive the therapy? Will there be restrictions on certain diseases? How might these genetic alterations affect future generations? The main question is: Will gene therapy prove to be an effective metastatic melanoma treatment? The answer has yet to be determined.
For all intents and purposes, metastatic melanoma should be considered incurable; therefore, the best melanoma treatment is prevention. The primary step in prevention is to reduce the risk of melanoma cancer development. Public education on the seriousness of this cancer is extremely important. Teaching people to recognize melanoma skin cancer symptoms and avoid known risk factors are important steps in decreasing the number of melanoma skin cancer fatalities. Although melanoma is considered genetic, one can take many precautions to avoid tumor formation.
Minimizing exposure to ultraviolet sources – whether through natural means or artificial sources, such as tanning beds and sun lamps – is an extremely important preventative measure. One should also wear sun protective clothing and sun block with an SPF of 30 or better. There are many medications that make the skin more sensitive to the sun. These medications treat numerous problems, including: acne, hypertension, high cholesterol, anxiety, depression, allergies and many more. At-risk individuals should be aware of the sun-sensitizing medications and discuss potential side effects with a medical professional or pharmacist.
The secondary step in prevention of melanoma cancer is the early detection of symptoms and possible tumors. After the age of 18, people should perform self screenings once a month to monitor for unusual nevi. Undergoing professional screenings every three to four years at a medical facility is also wise. After the age of 40, the ante should be upped to yearly screenings. Doctors and most nurse practitioners are trained in recognizing a tumorous mole from a harmless one. One must keep a close eye on all bodily lesions and immediately report any suspicious moles to a medical professional to ensure that melanoma cancer is caught before it has spread to other organs.