Skin cancers, including melanoma, are staged to measure how advanced they are, which helps determine the course of treatment. Many skin cancers can be removed with minor surgery using local anesthesia, often at a dermatologist’s office. More complex cases, such as melanoma, require the expertise of a medical oncologist. Melanomas that are localized may also be surgically removed, along with surrounding tissue that may have cancer cells in the margins around the tumor.
Most skin cancers are detected and cured before they spread. Melanoma that has spread to other organs presents the greatest treatment challenge. Standard treatments for localized basal cell and squamous cell carcinomas are safe and effective. Small tumors can be surgically excised, removed with a scraping tool (curette) and then cauterized, frozen with liquid nitrogen, or killed with low-dose radiation. Applying an ointment containing a chemotherapeutic agent called 5-fluorouracil — or an immune response modifier called imiquimod — to a superficial tumor for several weeks may also work. Larger localized tumors are removed surgically.
In rare cases where basal cell or squamous cell carcinoma has begun to spread beyond the skin, tumors are removed surgically and patients are treated with chemotherapy and radiation. Sometimes disfiguring or metastatic (spreading) basal cell skin cancers that are not able to be treated by surgery or radiation are treated orally with sonidegib (Odomzo) or vismodegib (Everidge). Melanoma tumors must be removed surgically, preferably before they spread beyond the skin into other organs. The surgeon removes the tumor fully, along with a safe margin of surrounding tissue. There is controversy whether removing nearby lymph nodes is valuable in certain cases. Neither radiation nor chemotherapy will cure advanced melanoma, but either treatment may slow the disease and relieve symptoms. Chemotherapy, sometimes in combination with immunotherapy — using drugs like interferon-alpha and interleukin-2– is generally preferred. If melanoma spreads to the brain, radiation is used to slow the growth and control symptoms.
Immunotherapy is a relatively new field of cancer treatment that attempts to target and kill cancer cells by manipulating the body’s immune system. Some of the most promising developments in the field of immunotherapy have sprung from efforts to cure advanced melanoma. Some researchers are treating advanced cases with vaccines, while others have used drugs such as interferon, interleukin-2, ipilimumab (Yervoy), nivolumab (Opdivo) or pembrolizumab (Keytruda) in an effort to stimulate immune cells into attacking melanoma cells more aggressively. Genetic manipulation of melanoma tumors may make them more vulnerable to attack by the immune system. Each of these experimental treatment approaches aims to immunize a patient’s body against its own cancer — something the body cannot do naturally.
There are also drugs that target specific gene changes within normal cells that cause them to become cancerous. Often called targeted therapy, these drugs include dabrafenib (Tafinlar), trametinib (Mekinist), and vemurafenib (Zelboraf). People who have had skin cancer once are at risk for getting it again. Anyone who has been treated for skin cancer of any kind should have a checkup at least once a year. About 20% of skin cancer patients experience recurrence, usually within the first two years after diagnosis.
Once skin cancer is diagnosed, the only acceptable treatment is medical care. Alternative approaches may be useful in cancer prevention and in combating nausea, vomiting, fatigue, and headaches from chemotherapy, radiation, or immunotherapy used to treat advanced skin cancer. Be sure to discuss any alternative treatments you are considering using with your cancer doctor.