Chemotherapy for advanced melanoma skin cancer
Chemotherapy uses anti cancer drugs to destroy cancer cells. Sometimes doctors use the word cytotoxic to describe the way chemotherapy works. Cytotoxic means toxic to cells.
Some people may have chemotherapy as a treatment for advanced melanoma skin cancer. This means the cancer has spread from where it started to another part of the body.
When you might have chemotherapy
Chemotherapy doesn’t work as well against melanoma as it does for some other types of cancer. So, doctors are more likely to use targeted cancer drugs or immunotherapy first.
Doctors may use chemotherapy after other treatments. Or you might have chemotherapy if you are not able to have the other treatments.
The aim of chemotherapy for advanced melanoma skin cancer is to control the cancer and relieve symptoms. This can help improve your quality of life
How you have chemotherapy
There are different ways to have chemotherapy for melanoma skin cancer.
Chemotherapy into your bloodstream
You normally have chemotherapy for melanoma into your bloodstream (intravenously). This is called systemic treatment. It means the chemotherapy reaches your whole body. The most common systemic chemotherapy drug for melanoma is dacarbazine.
You have dacarbazine as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover. Each cycle of treatment lasts 21 days (3 weeks).
Your doctor will tell you how many times you have dacarbazine each cycle and how many cycles you will have.
How you have chemotherapy into your bloodstream
To have chemotherapy, a nurse puts a small tube (cannula) into one of your veins. They connect a drip containing the chemotherapy to it. Or you may have it into a larger vein through a:
- central line
- portacath
- PICC line
Chemotherapy combined with electric pulses (electrochemotherapy)
If the melanoma comes back in your skin, you might have chemotherapy combined with electric pulses. You have this under a 
or a .
Your doctor injects the chemotherapy into your bloodstream or straight into the melanoma. And then puts a probe in or near the melanoma. The probe gives out electric pulses. These help the chemotherapy go into the cancer cells.
Chemotherapy just into your arm or leg
If the melanoma has come back in your arm or leg very near to where it started (a local recurrence) you might have regional chemotherapy. This is called isolated limb infusion or isolated limb perfusion. It is a way of having chemotherapy just into one arm or leg. The chemotherapy doesn’t go around the rest of your body so there are usually fewer side effects.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
Side effects
Common chemotherapy side effects include:
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feeling sick
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loss of appetite
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losing weight
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feeling very tired
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increased risk of getting an infection
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bleeding and bruising easily
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diarrhoea or constipation
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hair loss
Contact your hospital advice line immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.
Side effects depend on:
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which drugs you have
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how much of each drug you have
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how you react
Tell your treatment team about any side effects that you have.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
When you're at home
Chemotherapy for melanoma skin cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.
