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Treatment decisions

Find out about how your doctor decides which treatment you need for melanoma skin cancer, the types of treatment you might have and treatment by stage.

Deciding which treatment you need

Your specialist will be part of a team of health professionals who work together with you to decide on the best treatment for you. This team is called the multidisciplinary team (MDT).

There are 2 levels of MDT for melanoma and other skin cancers. They are the Local Hospital Skin Cancer Multidisciplinary Team (LSMDT) and a Specialist Skin Cancer Multidisciplinary team (SSMDT).

LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer centres, or plastic surgery centres. Everyone with suspected melanoma will see a member of one of these teams.

Your treatment depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • your general health and level of fitness

The depth of the melanoma in the skin affects how likely it is to come back and whether it may spread. The doctors use this information to diagnose what stage melanoma you have.

Making decisions

Your doctor might ask you to choose whether you have certain tests or treatments including:

  • tests to check your lymph nodes (sentinel node biopsy)
  • surgery to remove your lymph nodes, if the sentinel node biopsy shows they contain melanoma

To help you decide, the doctor will discuss the advantages and disadvantages of the tests and treatments with you. They can help you decide what to do.

Treatment overview

The main treatment for melanoma that hasn't spread is surgery.

If your melanoma has spread, the main treatments are:

  • biological therapy
  • chemotherapy
  • radiotherapy

Treatment by stage

Melanoma in situ (stage 0)

Surgery is the main treatment. To diagnose melanoma doctors remove the abnormal area of skin and a small area of surrounding skin. You may then need a second operation to remove a larger area of healthy tissue around where the melanoma in situ was. This is called a wide local excision. As long as the doctors are sure they removed enough tissue, this is all the treatment you need.  

Surgery can cause scarring and some people may not be well enough to have an operation. Instead of surgery, you might have treatment with a cream called imiquimod. You put imiquimod on the affected area, over a period of weeks.

Stage 1 and 2

Stage 1 and 2 melanoma are early cancers. The cancer is only in the skin and hasn’t spread to other parts of the body. Surgery is the main treatment.

After diagnosis, you usually have a second operation to remove a larger area of healthy tissue around where the melanoma was (a wide local excision). 

For most stage 1A melanomas, if your doctors are sure that they removed enough tissue, this is usually all the treatment you need.

For some stage 1A and all stage 1B and stage 2 melanomas, your doctor might offer you a test to check the lymph nodes nearest to the melanoma for cancer cells. The test is called a sentinel lymph node biopsy.

You usually have it while you're asleep (general anaesthetic) at the same time you have your wide local excision.

Sentinel lymph node biopsy

For most people with thin melanomas, cancer cells aren’t found in the nearby lymph nodes. But if they are (a positive sentinel lymph node biopsy) your stage of melanoma changes to stage 3.

Stage 3

You have surgery to remove the melanoma. Then you have a wide local excision to remove more tissue in the area where the melanoma was. 

If your melanoma has spread to the lymph nodes, you might need surgery to remove all of the lymph nodes in the area near the melanoma. This operation is called a lymph node dissection.

For stage 3B or 3C melanoma, your doctor might offer you radiotherapy to the area where the surgeon removed the lymph nodes. The doctor carefully weighs up the benefits of giving radiotherapy against the side effects.

Your doctor might ask you to join a clinical trial looking at biological therapy. Doctors are doing trials to see if biological therapy helps to stop stage 3 melanoma from coming back or spreading. You only have it for stage 3 melanoma as part of a clinical trial.

If you have melanoma between the main melanoma and nearby lymph nodes (in-transit metastases) you usually have surgery. If this is not suitable for you, you might have one of the following:

  • chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
  • radiotherapy
  • chemotherapy combined with an electric current (electrochemotherapy)
  • laser treatment using a carbon dioxide laser
  • cream to put on the skin (such as imiquimod cream)

Stage 4

Stage 4

Stage 4

Stage 4 means the cancer has spread to other parts of the body, such as the liver. It is also called advanced melanoma.

You might have one or more of the following treatments to help control the cancer and it's symptoms:

  • surgery
  • targeted cancer drugs
  • immunotherapy
  • radiotherapy to specific sites of melanoma spread, for example the bone or brain
  • injecting a drug directly into the melanoma (intralesional therapy), for example Talimogene laherparepvec (T-VEC)
  • laser treatment using a carbon dioxide laser
  • chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
  • chemotherapy combined with an electric current (electrochemotherapy)
  • chemotherapy – usually you would only have chemotherapy if you’re unable to have a targeted cancer drug or immunotherapy
  • take part in a clinical trial

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Information and help

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