It is natural to have questions about the treatment, its side effects, and the chances of cancer recurring. People with concerns should discuss them with a doctor who can offer advice that takes their medical history and overall health into account. Stage 4 melanoma is much more treatable today than it was a few decades ago. Monitoring moles and skin changes can help a person catch melanoma in the early stages and reduce the risk of it spreading.
People who do not respond to current treatments can also consider enrolling in clinical trials. These studies continue to look for new targeted drugs and combinations of treatments that can improve anti-cancer care and quality of life.
Anyone dealing with a stage 4 melanoma diagnosis should talk to a doctor frequently about their symptoms and reach out to loved ones and professionals for emotional support. A look at itchy moles, a common complaint that can have a variety of causes. Included is detail on how to tell if a doctor should examine a mole. Foot melanoma refers to cancer of the cells in the top layer of the skin on the foot.
This article looks closely at the types of foot melanoma and…. Melanoma is responsible for most skin cancer deaths, a major risk factor is sun overexposure.
Find out about its causes, symptoms, and treatment…. Seborrheic keratosis is a noncancerous condition that can look a lot like melanoma. In this article, learn about the difference and when to see a…. Bumps on the skin can be harmless. However, they can also point to more severe conditions, such as skin cancer. Learn all about common types of bumps….
Stage 4 melanoma: What you need to know. Melanoma and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care.
It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care.
And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment. Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.
You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan being recommended.
You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too. During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem.
Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Different treatments may be recommended for each stage of melanoma. General descriptions by stage are below. Your doctor will recommend a specific treatment plan for you based on the stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this page. Clinical trials may also be a treatment option for each stage. Stage I melanoma is usually treated with surgical removal of the tumor and some of the healthy tissue around it.
The doctor may recommend lymph node mapping, and some lymph nodes may be removed. The standard treatment for stage II melanoma is surgery to remove the tumor and some of the healthy tissue around it. While this surgery is being done, lymph node mapping and sentinel lymph node biopsy may also be done.
In some people with stage II melanoma, treatment with interferon may be recommended after surgery to lower the chances of the cancer coming back. Treatment in a clinical trial for stage II melanoma may also be an option. Ask your doctor about what clinical trials may be available for you. Stage III melanoma has spread locally or through the lymphatic system to a regional lymph node located near where the cancer started or to a skin site on the way to a lymph node.
If the stage III melanoma can be removed with surgery, then that will be the first treatment option. The lymph nodes may be checked for cancer and removed. After surgery, treatment with immunotherapy or targeted therapy may be recommended to help prevent the cancer from coming back. Treatment in a clinical trial for stage III melanoma may also be an option. Some of these research studies may involve treatment with systemic therapy before surgery, called neoadjuvant therapy.
This is not a standard treatment, but there is emerging data from clinical trials that this may be an effective approach for certain patients. Stage IV melanoma has spread to other distant parts of the body, such as distant lymph nodes or the liver, lung, brain, bone, or gastrointestinal tract. Doctors may refer to this as metastatic melanoma. If this happens, it is a good idea to talk with doctors who have experience treating it.
Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option.
Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
Unresectable stage III melanoma and stage IV melanoma are often treated the same way, with immunotherapy and targeted therapy, or, in rare cases, chemotherapy.
Palliative or supportive treatments intended to relieve symptoms may also be recommended, such as surgery or radiation therapy to treat affected lymph nodes and smaller tumors that have spread elsewhere in the body. The treatment plan will also depend on a number of factors:.
If the recommended treatment does not work, stops working, or causes serious side effects, your doctor may suggest changing the treatment plan. For most people, a diagnosis of advanced cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
The brain is one of the most common places to which melanoma spreads. Unfortunately, the presence of brain metastases is linked with a poor prognosis. Prognosis is the chance of recovery. Because of this poor prognosis and because of the perceived difficulty in getting chemotherapy drugs into brain tissue called the blood-brain barrier , people with melanoma that has spread to the brain have typically not been allowed into clinical trials. Fortunately, this is beginning to change, and there are clinical trials for patients with melanoma and brain metastases.
Read this fact sheet to learn more about cancer that has spread to the brain. Currently, the following treatments may be recommended for melanoma that has spread to the brain:.
Radiation therapy. High-dose radiation therapy given using stereotactic techniques is often used when there are only a few metastatic tumors in the brain. These techniques are highly effective for getting rid of existing tumors. However, they do not prevent new tumors from developing. The entire brain can be treated with radiation therapy, called whole-brain radiation therapy. However, because the dose of radiation used to treat the entire brain is lower, this type of treatment usually does not shrink tumors and commonly causes problems with thinking clearly cognition.
BRAF inhibitors. For people with melanoma that has a BRAF mutation, drugs such as dabrafenib and vemurafenib may be recommended. These drugs easily penetrate into the brain.
Ipilimumab, nivolumab, and pembrolizumab have recently been studied in clinical trials to treat people with melanoma that has spread to the brain. These trials have shown that these treatments can help patients with melanoma and brain metastases. In particular, the combination of ipilimumab and nivolumab appears to be the most effective therapy, although due to the high rate of side effects, this treatment may not be the right choice for everybody. Learn about caring for someone with cancer that has spread to the brain.
A remission is when cancer cannot be detected in the body and there are no symptoms. A remission may be temporary or permanent.
This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence. If the melanoma returns after the original treatment, it is called recurrent cancer.
It may come back in the same place called a local recurrence , nearby regional recurrence , or in another part of the body distant recurrence. When this occurs, a new cycle of testing will begin to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, immunotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace.
Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence. Recovery from melanoma is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal. This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss.
However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important. People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care.
Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.
Learn more about advanced cancer care planning. After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide. Melanoma: Types of Treatment Approved by the Cancer. For a person with melanoma, this team may include these doctors: Dermatologist: A doctor who specializes in diseases and conditions of the skin.
Surgical oncologist: A doctor who specializes in treating cancer with surgery. Surgery Surgery is the removal of the tumor and some surrounding healthy tissue during an operation.
Wide excision The main treatment for melanoma is surgical removal, or excision, of the primary melanoma on the skin. Lymphatic mapping and sentinel lymph node biopsy During this surgical procedure, the surgeon injects the area of the tumor with a dye and a radioactive tracer. Lymph node dissection If biopsy results show that cancer is found in the sentinel lymph nodes, this is called a positive sentinel lymph node. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.
Learn more about the basics of radiation therapy. Side effects of radiation therapy General side effects of radiation therapy include skin irritation, skin infections, and fatigue. Therapies using medication Systemic therapy is the use of medication to destroy cancer cells. The types of systemic therapies used for melanoma include: Immunotherapy Targeted therapy Chemotherapy Each of these types of therapies is discussed below in more detail.
Immunotherapy Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Interleukin-2 IL-2, Proleukin Another type of immunotherapy is interleukin-2, which activates T cells. Virus therapy Virus therapy is a type of immunotherapy.
Interferon High-dose interferon alfa-2b Intron A. KIT inhibitors Researchers are also focusing on the development of targeted therapies for the KIT gene, which is mutated or present in increased numbers extra copies of the gene in some tumors in certain subtypes of melanoma, including lentigo maligna melanoma, mucosal melanoma, and acral lentiginous melanoma. Tumor-agnostic treatment Larotrectinib Vitrakvi is a type of targeted therapy that is not specific to a certain type of cancer but focuses on a specific genetic change called an NTRK fusion.
Chemotherapy Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Isolated limb infusion therapy Sometimes melanoma may spread and appear as a number of tumors that develop in the leg or arm. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet UV radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan.
Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes mutations in the melanocytes, resulting in uncontrolled cellular growth. Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not.
Melanomas present in many different shapes, sizes and colors. Melanoma is usually curable when detected and treated early. Once melanoma has spread deeper into the skin or other parts of the body, it becomes more difficult to treat and can be deadly.
How and where it grows: It can arise in an existing mole or appear as a new lesion. When it begins in a mole that is already on the skin, it tends to grow on the surface of the skin for some time before penetrating more deeply. While it can be found nearly anywhere on the body, it is most likely to appear on the torso in men, the legs in women and the upper back in both. What it looks like: It may appear as a flat or slightly raised and discolored, asymmetrical patch with uneven borders.
It can also lack pigment and appear as a pink or skin-tone lesion amelanotic. What you should know: This form of melanoma often develops in older people. When this cancer becomes invasive or spreads beyond the original site, the disease is known as lentigo maligna melanoma. How and where it grows: This form of melanoma is similar to the superficial spreading type, growing close to the skin surface at first.
The tumor typically arises on sun-damaged skin on the face, ears, arms or upper torso. What it looks like: It may look like a flat or slightly raised, blotchy patch with uneven borders.
Color is usually blue-black, but can vary from tan to brown or dark brown. What you should know: This is the most common form of melanoma found in people of color, including individuals of African ancestry. How and where it grows: It often appears in hard-to-spot places including under the nails and on the soles of the feet or palms of the hands. What it looks like: It may appear as a black or brown area.
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