Melanoma Treatment

The pathologist always checks the edges of the wide excision to ensure there is no melanoma present (implying that if they see it at the edge then it is also present on the other edge that was left behind). Fortunately, this is very rare (<1%) for melanoma - unlike breast cancer lumpectomy which has a positive edge (margin) ~10-40% of the time. The pathologist always checks the edges of the wide excision to ensure there is no melanoma present (implying that if they see it at the edge then it is also present on the other edge that was left behind). Fortunately, this is very rare (<1%) for melanoma - unlike breast cancer lumpectomy which has a positive edge (margin) ~10-40% of the time.

Everyone is usually very anxious until the surgery is over so I try to schedule their surgery as expeditiously as possible - usually within a few days to a week. In the interim, the patient may be getting scans (PET/CT, brain MRI) and they usually get a lymphoscintigraphy (radioactive dye that we use to find the sentinel node(s)) the afternoon before or morning of surgery. I like my patients to get a good nights sleep before surgery and to take a shower with an antibacterial soap the morning of their surgery. Everyone is usually very anxious until the surgery is over so I try to schedule their surgery as expeditiously as possible - usually within a few days to a week. In the interim, the patient may be getting scans (PET/CT, brain MRI) and they usually get a lymphoscintigraphy (radioactive dye that we use to find the sentinel node(s)) the afternoon before or morning of surgery. I like my patients to get a good nights sleep before surgery and to take a shower with an antibacterial soap the morning of their surgery.

The amount of the metastatic deposit does have prognositic significance - the larger the deposit - the worse the prognosis; the more lymph nodes that contain melanoma - the worse the prognosis. There is a lot of controversy about adjuvant therapy (therapy for the entire body after the definitive surgery) for patients with node positive melanoma. Some oncolgists have the opinion there is no proven therapy that is effective while others believe in alpha-interferon (typically given for a full year after surgery). It is a bit of a 'belief' or 'faith' issue and should be discussed with your surgeon and medical oncologist. The amount of the metastatic deposit does have prognositic significance - the larger the deposit - the worse the prognosis; the more lymph nodes that contain melanoma - the worse the prognosis. There is a lot of controversy about adjuvant therapy (therapy for the entire body after the definitive surgery) for patients with node positive melanoma. Some oncolgists have the opinion there is no proven therapy that is effective while others believe in alpha-interferon (typically given for a full year after surgery). It is a bit of a 'belief' or 'faith' issue and should be discussed with your surgeon and medical oncologist.

There are particular indications for using radiation therapy in the treatment in melanoma and broken down into three categories: primary disease, regional disease, and metastatic disease. For primary disease, radiation may be considered as adjuvant treatment (following surgery) for patients with desmoplastic type melanoma with extensive neurotrophism- findings determined by a pathologist examining the specimen under a microscope. For regional disease the following are indications after surgery: extracapsular extension, the involvement of 4 or more lymph nodes (two or more lymph nodes if cervical lymph nodes involved, size of the primary tumor >3 cm, and recurrent disease after prior complete lymph node dissection. Finally, for metastatic disease radiation therapy may be used to treat brain metastases alone or after surgical resection, and other symptomatic or impending symptomatic involvement of bony metastases or soft tissue resection. For more information please see The National Comprehensive Cancer Network (NCCN) Guidelines. Margins are determined by a pathologist reviewing the surgical specimen and measuring the distance from where tumor is seen to the nearest point of normal tissue. There are particular indications for using radiation therapy in the treatment in melanoma and broken down into three categories: primary disease, regional disease, and metastatic disease. For primary disease, radiation may be considered as adjuvant treatment (following surgery) for patients with desmoplastic type melanoma with extensive neurotrophism- findings determined by a pathologist examining the specimen under a microscope. For regional disease the following are indications after surgery: extracapsular extension, the involvement of 4 or more lymph nodes (two or more lymph nodes if cervical lymph nodes involved, size of the primary tumor >3 cm, and recurrent disease after prior complete lymph node dissection. Finally, for metastatic disease radiation therapy may be used to treat brain metastases alone or after surgical resection, and other symptomatic or impending symptomatic involvement of bony metastases or soft tissue resection. For more information please see The National Comprehensive Cancer Network (NCCN) Guidelines. Margins are determined by a pathologist reviewing the surgical specimen and measuring the distance from where tumor is seen to the nearest point of normal tissue.

Brachytherapy for the treatment of melanoma is used for the treatment of choroidal or uveal (intraocular) melanoma as an eye-sparing technique. It is also referred to as plaque brachytherapy and can be performed with several isotopes including Iodine 125 (125I), gold 198 (198Au), palladium 103 (103Pd), and others. Guidelines are available by the American Brachytherapy Society: http://www.eyephysics.com/PS/PS5/UserGuide/References/PDF/Red_J_Articles/AmerBrachyRec03.pdf Brachytherapy for the treatment of melanoma is used for the treatment of choroidal or uveal (intraocular) melanoma as an eye-sparing technique. It is also referred to as plaque brachytherapy and can be performed with several isotopes including Iodine 125 (125I), gold 198 (198Au), palladium 103 (103Pd), and others. Guidelines are available by the American Brachytherapy Society: http://www.eyephysics.com/PS/PS5/UserGuide/References/PDF/Red_J_Articles/AmerBrachyRec03.pdf