How Nodular Melanoma Is Treated

Nodular melanoma is an aggressive form of skin cancer that grows faster than other kinds of melanoma.

If found early, nodular melanoma can usually be treated and oftentimes cured. However, because of this type of cancer’s fast-growing nature, it is often only discovered once the condition is advanced.

Treatment is focused on curing cancer, preserving skin appearance, and preventing cancer from returning. Treatment options may include surgery, chemotherapy, immunotherapy, radiation therapy, and targeted therapy.

Learn more about the different kinds of treatment for nodular melanoma.

Doctor comforting patient in surgery

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Surgery

In the majority of cases, treating nodular melanoma almost always requires surgery.

Surgery is the primary treatment for all forms of melanoma at all stages. Surgery may be used to cure nodular melanoma in the early stages, but also to treat advanced-stage nodular melanoma.

There are a number of surgical options for the treatment of nodular melanoma, depending on the size and location of the cancerous growth.

Wide Excision Surgery

During this procedure, the nodular melanoma is surgically removed, along with some surrounding tissue, known as the margin.

The amount of surrounding tissue that is removed depends on:

  • Location of the tumor
  • Thickness of the tumor
  • Potential impact on personal appearance

In some cases, skin grafting is performed to cover the wound caused by wide excision surgery. This involves taking skin from elsewhere on the body and applying it to the area where the skin was surgically removed.

Sentinel Lymph Node Biopsy

Like other melanomas, nodular melanoma can spread to lymph nodes as it advances.

A sentinel lymph node biopsy is a surgical procedure performed to see if the melanoma has spread to the sentinel lymph nodes.

The sentinel lymph nodes are the first lymph nodes where cancer is expected to spread. If there is evidence of cancer there, then it is possible for cancer to spread to other parts of the body through the lymphatic fluid.

A sentinel lymph node biopsy is often recommended for those at risk of having their melanoma metastasize, meaning spread, to lymph nodes.

During this procedure, a radioactive blue dye is injected close to the nodular melanoma. The fluid travels through the lymph ducts and to the sentinel lymph nodes. The surgeon will use imaging studies to see which lymph nodes contain the most dye, and those nodes will be surgically removed.

The tissue of the lymph node is then examined under a microscope to see if there are cancer cells. If cancer is found, further testing will be needed to determine if the cancer has spread further.

Other Surgery

If cancer has spread from the primary site of the tumor to lymph nodes or other organs like the lungs, brain, or liver, surgery may be performed to remove other tumors to control symptoms and improve quality of life.

Chemotherapy

If nodular melanoma has spread, chemotherapy may be recommended. Chemotherapy is a medicine that either kills cancer cells or helps stop them from dividing and then multiplying.

Chemotherapy may be given by mouth or injected into the muscle or through a vein.

In some cases, chemotherapy drugs may be given directly into an organ, into the cerebrospinal fluid, or into a particular cavity in the body like the abdomen. This is called regional chemotherapy and may be used to target cancer cells in a specific part of the body.

The method through which chemotherapy is administered will vary based on the stage of nodular melanoma and where it has spread.

Immunotherapy

Immunotherapy is a form of cancer treatment that helps the immune system fight cancer. Drugs are used to teach the immune system to recognize cancer and fight it off.

Immunotherapy has been found to be very effective when used to treat advanced nodular melanoma.

There are a number of immunotherapy drugs. In the treatment of nodular melanoma, a class of drugs called checkpoint inhibitors are commonly used. These work by blocking the action of a molecule that acts as a brake for a type of immune cell called T-cells. This releases the brake, helping to spur T-cells into action finding and killing cancer cells.

Immunotherapy is often used in the treatment of advanced nodular melanoma or in nodular melanoma that can’t be removed via surgery.

Radiation Therapy

Radiation therapy can be used in a variety of ways in the treatment of nodular melanoma.

It may be used in combination with immunotherapy or other drugs to ensure treatment has lasting efficacy, it can be used following surgery for nodular melanoma to stop the cancer from returning, or it may be used to ease symptoms that are caused by tumors in the body.

In radiation therapy, high-energy rays are directed toward the part of the body where cancer is present. The radiation damages the DNA of cancer cells. In doing so, it kills the cancer cells or prevents them from growing any further.

Targeted Therapy

Nodular melanomas often have mutations in their DNA. Researchers have found a number of genetic mutations in nodular melanoma. BRAF mutations are the most common form of mutation in all types of melanoma, occurring in about half of cases.

Targeted therapy is a cancer treatment that uses drugs to target certain cells that contain these mutations. This then helps to shrink a tumor or stop it from growing as quickly.

A class of targeted therapy drugs called BRAF inhibitors is being used to shrink or slow the growth of tumors that contain a BRAF mutation. These are commonly used in the treatment of nodular melanoma that has a BRAF mutation and has spread to other parts of the body.

The advantage of targeted therapy over other cancer treatments like chemotherapy is that since it targets specific cancer cells, it causes less damage to regular cells, which means it may also cause fewer side effects.

Researchers are working to develop targeted therapy drugs for other gene mutations identified in nodular melanomas, such as NRAS and KIT.

New Treatments in Clinical Trials

Clinical trials are currently underway to test new treatments for nodular melanoma. These treatments are not yet available to the public.

One treatment that is currently undergoing clinical trials is vaccine therapy. This involves using certain substances to help stimulate the immune system. Once the vaccine therapy has been administered, the stimulated immune system can then locate and kill tumors in the body.

This treatment is being studied for the treatment of stage 3 melanoma that can’t be effectively treated through surgery.

In some cases, participating in a clinical trial may be the best treatment option for a person with cancer. In a clinical trial, a cancer patient may be one of the first to receive a new treatment.

If you have advanced nodular melanoma and are interested in participating in a clinical trial, you should speak with your healthcare team about the options being studied and what might work for you.

A Word From Verywell

Nodular melanoma is an aggressive form of skin cancer. If found early, treatment is highly successful, and in many cases, nodular melanoma can be cured.

However, because nodular melanoma is fast-growing, it is often not discovered until in the advanced stages. Regardless of the stage that your cancer is found, a number of treatment options are available that can help. These include surgery, chemotherapy, immunotherapy, radiation therapy, and targeted therapy.

Clinical trials are ongoing to discover new therapies for the treatment of nodular melanoma, and those with advanced forms of cancer may benefit from participating.

If you have questions about your treatment options or need guidance in finding support through your cancer journey, don’t hesitate to reach out to your healthcare team. They can answer your questions and point you toward the resources you need.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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