Treating Melanoma

  • Hassan Arshad, MD, surgeon in the department of head and neck surgery/plastic and reconstructive surgery.

More Options, Better Outcomes

For melanoma patients, an individualized plan, developed by a team of melanoma specialists, will likely include one or more of the following therapies:

Surgery

Removing the cancer surgically is almost always the primary treatment for melanoma. For cancers that have not spread beyond the epidermis, surgery alone may be curative.

Melanoma surgery may involve:

  • Wide local excision: Surgery to remove the cancer along with some surrounding healthy tissue, leaving the margins (bordering tissue) free from cancer. If necessary, surgeons repair the surgery site with a skin graft.
  • Lymphadenectomy: Surgery to remove one or more lymph nodes in the tumor area. Nodes are then examined for cancer by the RPCI pathology department.
  • Plastic and reconstructive surgery: Surgery to restore or improve the appearance and/or function of body structures.

Medicines

These treatments use drugs to attack your cancer in various ways, and may be given before and/or after surgery.

  • Immunotherapy: Also called biological therapy, these drugs boost your immune system’s ability to find and destroy cancer cells and/or prevent cancer cells from growing.
    • Imiquimod is a medicine in cream form that is applied to the tumor’s surface.
    • Bacillus Calmette-Guérin and Interferon alfa are drugs that are injected into the tumor.
    • Interleukin-2 (IL-2) is a potent immune therapy for certain melanoma patients. It works by tricking the body into thinking it has a severe infection and the body’s immune system mounts a major response to fight it. It is given in very high doses and can produce significant immune system-related side effects. For this reason, RPCI treats patients with IL-2 in a dedicated clinic where the staff is specially trained to administer the therapy and treat any reactions.
    • Ipilimumab is the latest FDA-approved drug for melanoma. Like IL-2 therapy, Ipilimumab is administered in the hospital under watch of a special care team.
  • Targeted therapy: This treatment uses a drug to target or change the activity of a specific feature of the melanoma cell. For example, Vemurafenib is a drug that targets tumors that have a damaged BRAF gene. Only patients with this specific melanoma type benefit from this treatment. Other targeted therapies are available through clinical research studies.
  • Systemic chemotherapy: May be part of your treatment if your melanoma has spread beyond the skin. Given intravenously (IV) or taken orally (by mouth), the drugs circulate the body, seeking rapidly-dividing cancer cells to destroy. While several chemotherapy drugs are available for melanoma, no single agent has been proven to work better than the others. If your treatment plan includes systemic chemotherapy, your RPCI oncologist will choose the drug or combination of drugs that match your situation.

RPCI is the only care center in Western New York that offers these regional chemotherapy treatments:

  • Isolated Limb Perfusion (ILP): Also called isolated arterial perfusion, this treatment is a type of regional chemotherapy that treats only the affected limb, such as the arm or leg. After surgery to remove as much of the cancer as possible, high doses of chemotherapy drugs are placed directly in the blood vessels leading to the affected limb. Blood flow to the limb is temporarily halted, keeping the treatment at the tumor site and preventing the drugs from circulating to rest of the body.
  • Isolated Limb Infusion (ILI): A less invasive regional therapy similar to ILP that takes advantage of smaller catheters directed into the affected limb by skilled interventional radiologists.

Radiation Therapy

Also called radiotherapy, this treatment directs high-energy radiation at the cancer cells to kill them or to keep them from growing. Your melanoma treatment plan may include radiation therapy after your surgery in order to kill any remaining cancer cells, if your melanoma has recurred, or if it spread to other sites. Radiotherapy may be recommended as:

At RPCI, we offer the latest radiation technology and procedures, including:

  • External beam radiation
    • 3D Conformal Radiation Therapy (3D CRT)
    • Intensity Modulated Radiation Therapy (IMRT)
    • Volumetric Modulated Arc Therapy (VMAT)
  • Gamma Knife stereotactic radiosurgery: Called surgery without a scalpel, this noninvasive technology is used for treating melanoma lesions that have metastasized to the brain. Gamma Knife treatment delivers high dose radiation to small, critically located targets in the head, without incisions and need for general anesthesia.
  • Varied Dosing Schedules (Fractionation Schemes)

RPCI Advantage — Meet Dr. Kilian Salerno

RPCI has a dedicated radiation oncologist who specializes in melanoma. If you are treated at RPCI for melanoma, and your treatment plan calls for radiotherapy, you will see Dr. Kilian Salerno.