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Chemotherapy for melanoma

Chemotherapy uses anti cancer drugs to destroy cancer cells. You may have chemotherapy as a treatment for an advanced melanoma that has spread to another part of the body. You may have one chemotherapy drug or a combination of several drugs. You usually have injections or tablets for a few days. Then you will have 3 or 4 weeks without any drugs. Then you have another few days of drugs. This cycle is usually repeated six or more times to make up a complete course of chemotherapy.

Side effects

Different drugs have different side effects. And some people react more than others. Some common side effects of chemotherapy include a drop in the number of blood cells, feeling sick, diarrhoea, hair loss or thinning, a sore mouth, feeling tired, and loss of fertility.

Chemotherapy into an arm or leg

If the melanoma comes back in the original area (local recurrence) some people have chemotherapy given just into one arm or leg. The drugs do not then circulate through the rest of the body. It is called regional chemotherapy.

 

CR PDF Icon View and print the quick guide for treating advanced melanoma.

 

 

What chemotherapy is

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

 

When you might have chemotherapy

You may have chemotherapy as a treatment for advanced melanoma that has spread to another part of the body.

Or you may have chemotherapy to try to stop your melanoma coming back if melanoma cells were found in your lymph nodes when the melanoma was removed. Chemotherapy used in this way is called adjuvant chemotherapy. It hasn't yet been proved that it helps to prevent melanoma from coming back. So you should have adjuvant chemotherapy as part of a clinical trial. There is information about taking part in a clinical trial in our clinical trials section.

You can have chemotherapy for melanoma

  • As tablets or capsules that you swallow
  • As a liquid into a vein
  • Into one arm or leg as regional chemotherapy
 

Chemotherapy as capsules or into a vein

You may have one chemotherapy drug or a combination of several drugs. You usually have your injections or tablets for a few days. Then you have 3 or 4 weeks without any drugs. Then another few days of drugs. This cycle is usually repeated 6 or more times to make up a complete course of chemotherapy.

The chemotherapy drug most commonly used to treat advanced melanoma is called dacarbazine (DTIC). Sometimes it is used with other chemotherapy drugs, such as carmustine (BCNU), vinblastine, or cisplatin. Another chemotherapy drug, temozolomide (Temodal), is very similar to dacarbazine. It is taken as capsules. These drugs may be given with the hormonal therapy drug tamoxifen

Chemotherapy drugs may sometimes be combined with biological therapy drugs for melanoma.

 

Side effects

Chemotherapy has side effects. The side effects you have depend on

  • Which drugs you are given
  • How much of each drug you are given
  • How you individually react to the drugs

The side effects vary from person to person. Some people have more side effects than others. And different drugs have different side effects. So we can't tell you exactly what will happen to you. But here is a list of some common side effects

The links above take you to information about coping with the side effects. You can also look at our section on chemotherapy side effects for general information. You can ask your doctor or nurse which of these side effects are most common with the chemotherapy drugs you will have. Or you can look at our general cancer organisations list for other sources of information about chemotherapy.

If you are having several different drugs, you may find the side effects difficult to cope with. But there is quite a bit that can be done to help. And most side effects only last for the few days that you actually have the drugs. Tell your doctor, nurse or pharmacist about any side effects as soon as they develop. They can then help you as much as possible.

You may get very tired towards the end of your course of treatment. The side effects will gradually go once your treatment has ended, but it will take you a while to get your energy back.

 

Chemotherapy into an arm or leg (regional chemotherapy)

Regional chemotherapy is a way of having chemotherapy just into one arm or leg, without the drugs circulating through the rest of your body. Doctors only use it if your melanoma has come back in an arm of leg very near to where it started (a local recurrence).

If you have not had your lymph nodes removed before, the surgeon will remove them during the operation. This helps to reduce the risk of the melanoma spreading. There is information about removing lymph nodes on the page about treatment for medium stage melanoma.

Regional chemotherapy treatment was first used 25 years ago. Clinical trials are still going on with new combinations of chemotherapy drugs and sometimes biological therapy. There are 2 types of regional chemotherapy for melanoma. They are

Isolated limb infusion (ILI)

You have this treatment under general anaesthetic. The surgeon puts tubes into the blood vessels that carry blood in and out of the limb. This disconnects the blood supply to the limb from the rest of the blood circulating around the body. The surgeon then connects the tubes to a pump and a machine that puts chemotherapy into the blood. The blood may also be heated, because some studies show better results from warming the blood a degree or two. This may be because the blood vessels expand at a higher temperature to let more blood into the body tissues.

DIagram showing isolated limb infusion

Once the machine is connected you can have a high dose of chemotherapy or biological therapy into the blood circulated through that arm or leg without having any effect on the rest of the body. After a short time, the surgeon reconnects the blood vessels and your blood circulation goes back to normal.

Isolated limb perfusion (ILP)

Isolated limb perfusion is very similar to isolated limb infusion. But as well as giving chemotherapy or biological therapy into the blood going into the limb the machine also gives oxygen. Then you can have the treatment for a longer time. 

Diagram showing regional limb perfusion

You have this treatment under general anaesthetic. It takes about an hour. The surgeon then reconnects the blood vessels and your blood circulation goes back to normal.

 

Side effects of regional chemotherapy

You don't have the usual side effects of chemotherapy with this type of treatment. The drugs don't circulate through the rest of your body in high enough amounts to make you lose your hair or feel sick. 

You will have quite a bit of soreness in the shoulder or groin where the tubes go in and out. Your nurse will give you painkillers as you need them. If the drugs don't control your pain, tell your doctor or nurse as soon as possible. You may need a higher dose, or a different type of painkiller.

You will also have some redness and swelling of the arm or leg. The redness and swelling usually starts about 48 hours after your treatment. The redness of the skin will gradually fade to brown. This may be quite dark at first, but will become lighter over the next few months. The skin colour is usually back to normal after about six months. But you may have a permanent change of skin colour in your arm or leg. You will also lose any hair you had on your arm or leg. Some people have some blisters or peeling skin on the sole of the foot or palm of the hand.

While you are recovering in hospital, your nurse will listen to the pulse and blood flow in your arm or leg every day. This is because there is a risk of developing a blood clot in your arm or leg. If you have pain anywhere in your limb, tell your doctor or nurse straight away because this may be a sign of a blood clot. If you do get a blood clot, you will have anti clotting drugs. You will have to stay in bed a little longer.

On rare occasions, small amounts of the chemotherapy may get into the rest of the body. Depending on the drug, this can cause mild kidney or liver problems. But a reaction like this is usually temporary. And your doctors and nurses will be checking for it. So it should be picked up quickly if it happens to you.

There can be long term side effects, such as

  • Swelling in the treated arm or leg (lymphoedema)
  • Muscle wasting

New combinations of chemotherapy and biological therapy drugs are tried in regional chemotherapy from time to time. So your doctors may not know exactly what the long term side effects of your treatment will be. If you have the treatment as part of a clinical trial, the staff will tell you as much as they can before you start the treatment. But if there is anything else you want to know, do ask your doctor or nurse.

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed any remedies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

 

More information on chemotherapy

For general information about having chemotherapy look at the chemotherapy section. It explains the treatment in detail including

If you would like to have a booklet about chemotherapy, ask your doctor or chemotherapy nurse. Or look at our reading list about cancer and treatments.

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Updated: 23 January 2014