Surgery (an operation) is the main treatment for melanoma.
In some cases you are offered treatment with medicines such as chemotherapy, immunotherapy or targeted therapies.
Deciding treatment
A team of specialists will be involved in your care. Your care team is sometimes called a multidisciplinary team (MDT).
This team may include a dermatologist, plastic surgeon, medical oncologist, radiation oncologist (radiotherapy specialist), histopathologist, radiologist and specialist nurse.
When helping you decide on your treatment, the team will consider:
- the type of cancer you have
- the stage of your cancer (its size and how far it has spread)
- your general health
They will talk to you about the treatment options they think are best for you. But the final decision is yours.
Before going to your appointment to discuss treatment, write down any questions you may have. For example, you could ask about the advantages and disadvantages of each type of treatment.
Surgery
You usually have surgery to treat stage 1 and 2 melanoma. This is to remove the melanoma and a small area of normal skin around it. This is called excision.
Excision is usually done under local anaesthetic. You'll be awake but the area around the melanoma will be numbed, so you will not feel pain.
In some cases, you will have a general anaesthetic. This means you will be asleep for the procedure.
Wide local excision
After the melanoma is removed and examined, most likely you will need more surgery. This surgery is called wide local excision. Wide local excision is a procedure to remove healthy-looking skin around and below where the mole was. This will help prevent the cancer coming back.
If you have stage 1B to 2C melanoma, you may be offered a sentinel lymph node biopsy. This is a test to check if the cancer has spread to the lymph glands. It can be done at the same time as wide local excision.
Skin graft or flap
Sometimes, to help repair the wound your surgeon will do a:
- skin graft - skin is taken from another part of your body and placed on the wound site
- skin flap - thick layer of skin with its own blood supply is attached to the wound area
In most cases, surgery is the only treatment you need. You may have check-ups for 1 to 5 years after surgery.
Lymph node surgery
If you have stage 3 melanoma you may have affected lymph nodes removed. This surgery is known as lymph node dissection or completion lymphadenectomy.
Or you may have regular ultrasound examinations to monitor the area for changes.
Cancer medicines
Your care team may recommend treatment with cancer medicines. These will be to either kill or slow the growth of cancer cells.
Chemotherapy
Chemotherapy uses medicines to kill cancer cells.
It is also known as cytotoxic chemotherapy or cytotoxic cancer medicine. Cytotoxic means toxic to cells.
Immunotherapy
Immunotherapy medicines can either:
- use your immune system to find and kill cancer cells
- boost your immune system and help it work better to fight cancer cells
You may have tests to check if immunotherapy is likely to work for you. These are called biomarker tests.
Targeted therapy
Targeted therapy uses medicines to find and attack cancer cells.
Targeted therapy medicines target parts of cancer cells that have gene changes (mutations) that make them different from normal cells.
You will only be offered targeted therapy if your cancer has these gene changes.
You may have tests to check if targeted therapy is likely to work for you. These are called biomarker tests.
Treating advanced melanoma
Stage 4 melanoma is when the cancer comes back or it spreads to other organs. It is also called advanced melanoma.
Treatment for advanced melanoma aims to control the cancer rather than cure it. It focuses on slowing the growth of the cancer, easing symptoms and helping you live longer with a good quality of life.
Your care team may also refer you to the palliative care team. These are specialists in managing symptoms such as pain and improving your quality of life.
Follow up
After your treatment, you'll have regular follow-up appointments for 1 to 5 years to check if:
- there are signs of the melanoma coming back around the scar
- the melanoma has spread to your lymph nodes or other areas of your body
- there are signs of any new melanomas
Your doctor or nurse will examine you. They'll ask about your general health and answer any questions you may have.
Help and support
Being diagnosed with melanoma can be difficult to deal with. You may feel shocked, upset and frightened. These types of feelings are natural.
You can ask your care team about anything you're unsure about.
Your family and friends can be a great source of support. Talking about your cancer and how you're feeling can help both you and members of your family cope with the situation.
Some people prefer to talk to people outside their family.
Some organisations have specially trained staff you can speak to.
These include:
Content supplied by the NHS and adapted for Ireland by the HSE
