After the diagnosis, the treatment takes place. Which method is used depends on several factors, such as size and stage of the tumor and existence of metastases. Sometimes some treatment options are used in combination.
Surgery is the main treatment measure for melanoma. This operation is done under local anesthesia. The doctor removes the tumor with a safety margin. Depending on tumor size, few centimeters of healthy tissue are removed around the tumor in order to prevent a recurrence.
If larger wounds and defects formed during the surgical removal of malignant melanoma, the doctor can treat them through a skin graft or other surgical procedures.
If there is a risk that the nearby lymph nodes are also affected, we also investigated the sentinel lymph nodes. These are examined in detail. If they are already infested than nearby lymph nodes are also removed.
In some melanomas, surgery is not suitable. Then radiotherapy is used. Even in patients in which the lymph nodes are involved or who developed distant metastases, radiation therapy may be useful after surgery. With high-energy radiation, tumor cells are destroyed and thus prevented from further growth. As the surgical treatment, the radiation therapy is a local treatment method: Only those cells are destroyed which are within the irradiation field. Radiation therapy is often used in the treatment of brain metastases or large, inoperable metastases in the face.
In chemotherapy, drugs ( cytostatic ) are used that inhibit the growth of tumor cells. This treatment is particularly useful in rapidly growing cells, which include cancer cells effectively.
Here, one or more cytotoxic (anti-cancer agents) are given into a vein or given as a pill. Examples include dacarbazine, Temodal gemcitabine / treosulfan etc. The drug is introduce in the bloodstream and can reach the entire organism.
The chemotherapy may also used as a preventive treatment measure which may kill cancer cells remaining after surgery, thus increasing the chances of healing . This approach has proved, advantageous for those patients in which metastasis of lymph nodes have already been established. Separately, chemotherapy may be used as potentially life-saving measure in patients where melanoma metastases cannot be completely removed by surgery.
This refers to treatments that are designed to strengthen the immune system of the body, so it is better with the tumor. The substances used for this purpose are produced by the body itself particularly with infection in small quantities. These include, for example, the interferons or interleukin-2. Today ipilimumab, Nivolumab and Pembrolizumab be used in patients with distant metastases. they have similar modes of action, and is associated with an increased activation of the tumor destroying immune cells.
If there are metastasis or specific genetic mutations in melanoma, specific drugs (vemurafenib, Dabrafenib, trametinib, imatinib, dasatinib, etc.) can be used to block the mutation related cell signal transmissions. These mutations include BRAF and Kit mutations
With early treatment and complete removal of malignant melanoma, the prognosis is good. If the melanoma has metastasized, the prognosis is unfavorable.
Experts recommend an intensive follow-up, especially in the first five years after surgery. Patients should be carried out regularly check-ups within the first ten years. How hard they make will depend upon factors including the original tumor characteristics, such as size, lymph node involvement or existing metastases.