Early-Stage Melanoma Treatment Options

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Your doctor says that your skin biopsy came back positive for melanoma, the most aggressive form of skin cancer. Fortunately, it was caught at an early stage melanoma (0, I, or II), so your prognosis is good. But what's next? What are your treatment options? Here is an overview of what to expect.

If you have heard a description of your melanoma but are uncertain of the stage, learn about the staging of melanoma. If your melanoma is instead a stage III or stage IV (metastatic) melanoma, learn about the treatment options for advanced stage melanoma.

Stage 0 (In Situ) Melanoma

Stage 0 ("in situ") melanomas have not spread beyond the epidermis (the top layer of skin). They are usually treated with surgical removal ("excision") of the melanoma and a minimal amount (about 0.5 cm) of normal skin (called the "margin"). Surgery at this stage usually cures the disease. For melanomas on the face, some doctors may instead prescribe a cream containing the drug Aldara (imiquimod). This is mainly used when surgery would create a cosmetic problem. The cream is applied anywhere from once a day to two times a week for around three months.

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Melanoma in situ
Melanoma in situ. DermNet / CC BY-NC-ND

Stage I Melanoma

Treatment of stage I melanoma (that is, lesions 2 mm in thickness or less) consists of surgical removal of the melanoma and removal of 1 cm to 2 cm of normal skin surrounding it, depending on the thickness of the melanoma (called the "Breslow thickness"). Depending on the location of the melanoma, most people can now have this procedure performed in an outpatient clinic or doctor's office.

Routine lymph node dissection (removal of lymph nodes near cancer) has not been shown to improve survival in patients with stage I melanoma. Some doctors recommend sentinel lymph node mapping and biopsy if the melanoma is stage IB or has other characteristics that make spread to the lymph nodes more likely.

Stage II Melanoma

Wide excision is the standard treatment for stage II melanoma. If the melanoma is between 1 mm and 2 mm thick, a 1 cm to 2 cm margin of normal skin will be removed as well. If the tumor is 2 mm to 4 mm thick, at least 2 cm of normal skin will be removed from around the tumor site. If the tumor is more than 4 mm thick, a margin of 3 cm is recommended when anatomically possible.

Since the melanoma may have spread to lymph nodes near the tumor, some doctors may recommend a sentinel node lymph biopsy as well. In this procedure, a dye and a radioactive tracer are injected into the melanoma before surgery is performed. Melanomas spread by way of either the lymphatic system or the bloodstream. When they spread through the lymphatic system, they usually first spread to the lymph nodes that are closest to cancer, and once they spread to a first lymph node, spread down the line to others. Doing a sentinel node biopsy allows the surgeon to determine if a melanoma has begun to spread.

If the sentinel node(s) is found, it will then be biopsied along with removing the melanoma. If the sentinel node contains cancer, then a lymph node dissection (where all the lymph nodes in that area are surgically removed) will be done at a later date.

It's important to note that if there is evidence that cancer has spread to the sentinel node or other lymph nodes, this does not mean that it is metastatic. On your biopsy report it will likely say "metastatic to lymph nodes" but again, this does not mean that your cancer is metastatic, but only that it has the potential to become metastatic.

In certain cases (such as if the tumor is found to be more than 4 mm thick or if lymph nodes contain cancer), some doctors may advise adjuvant therapy (additional treatment after surgery) with interferon-alfa2b. Other drugs or perhaps vaccines may also be recommended as part of a clinical trial to try to reduce the chance that the melanoma will come back. Current evidence for the effectiveness of adjuvant drug or radiation treatment for stage II patients, however, is limited.

Newer treatments are becoming available for melanoma all the time and even more, are being studied in clinical trials. Talk to your doctor about whether you may be a candidate for any of these studies. If you have stage II melanoma it's also very important to be your own advocate in your cancer care.

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  1. American Cancer Society. Treatment of Melanoma Skin Cancer, by Stage. Updated August 14, 2019.

  2. Neuwirth MG, Bartlett EK, Karakousis GC. Lymph node dissection for melanoma: where do we standMelanoma Manag. 2017;4(1):49–59. doi:10.2217/mmt-2016-0023

  3. National Cancer Institute. Melanoma Treatment (PDQ®)–Health Professional Version. Updated April 11, 2019.