Your treatment options depend on the stage of melanoma, your overall health, and your preferences about treatment. In metastatic disease, the location and extent of the melanoma is also an important consideration.  In all cases, treatment should be individualized for you. Although melanomas are classified into a particular stage, each person and each melanoma is unique.

You do not have to rush to make a decision, so consider the options carefully. Ask questions if you do not understand any aspect of the treatment or the terms your doctors are using.

COMMUNICATION

You have the right to understand medical terms and treatment options. You should make sure that you communicate your beliefs and expectations about treatment to your doctor. 

Research shows that cancer survivors of all educational levels and backgrounds can have a hard time communicating with their healthcare team. For example, after office visits, you have many questions that you didn’t ask for answers you still don’t understand. Or you may find that you never have enough time during office visits to ask all of your questions or to say what is on your mind. Communication may be at the heart of your problem. 

One of the best ways to improve communication with your health care team is to prepare for your visits so that you can make the best use of everyone’s time. 

DEVELOPING A TREATMENT PLAN

A treatment plan is a way to deal with the short- and long-term goals for managing your melanoma. The treatment plan might include regular skin examinations, routine laboratory and radiology tests, additional treatment with radiation therapy, immunotherapy, chemotherapy,  or enrollment in a clinical trial.

Some tips to develop your treatment plan:

•  Make a list of the various treatment options for your stage of melanoma.

•  Compare/contrast the benefits and risks of the different options.

•  Look for consensus in treatment options — through second or third opinions.

•  Determine how the various treatment options could affect your life (for example, side effects of treatment, the frequency of office visits, impact on family and lifestyle). 

•  Use a calendar and notebook to keep track of appointments, questions, and important information. Bring this with you to all of your appointments.

•  Consider where you will go or who you will turn to for emotional support.

•  Make a “wish list” based on the information and decisions you have reviewed and made:

 •  Your ideal treatment plan  (medical/surgical and length)

 •  Your ideal location for treatment 

 •  Your ideal follow-up schedule

 •  Your ideal outcome

•  Develop a plan to address other areas of your life, such as financial planning and the development of a living will. It is easier to make these types of plans when you are feeling well. 

GETTING A SECOND OPINION 

If you have been diagnosed with melanoma, it is a good idea to consider a second opinion of your diagnosis and treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if requested by you or your doctor. Do not feel uncomfortable about asking for a referral to another specialist. 

It is best to get a second opinion before you begin a course of treatment since it is difficult to change your treatment plan once started.

Standard treatment for specific stages is given in detail:

Surgery 

Surgery is the mainstay of therapy for early-stage melanoma. In Stage 0-III melanoma, the primary lesion is surgically excised, along with any affected lymph nodes or in-transit metastases (metastases between the primary site and the nearby lymph nodes). 

In patients with Stage IV melanoma, where the melanoma cells have spread to other areas of the body, surgery may also be useful in removing a single (or sometimes several) melanoma metastases or one that is causing dysfunction or symptoms.

Types of Surgery 

Simple Excision Thin melanomas are surgically removed, along with a small amount of non-cancerous skin at the edges. This procedure can result in a complete cure for most patients with thin melanomas.

Mohs Surgery Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas (the common, non-melanoma skin cancers). The Mohs procedure is a surgical treatment in which the physician removes small sections of apparently normal skin beyond the visible melanoma and immediately looks at it under a microscope to identify the presence of abnormal cells. If abnormal cells are identified, another small section is removed. This process is continued until the cells removed no longer look abnormal and it reduces the extent of scarring. A Mohs surgeon is specially trained in surgery, pathology, and reconstruction.

Most melanoma experts believe that Mohs surgery does not have a proven place in melanoma surgery. 

Wide Local Excision

A “wide” local excision is performed to decrease the chance of local recurrence. In a wide local excision, a margin of normal tissue, usually 1-2 cm, is removed from the original melanoma site. This tissue is then sent to a pathologist for evaluation to determine the actual microscopic margins (how far the “last” tumor cell is from the edges of the removed tissue). The aim is to remove all of the tumor cells and to leave the smallest and most cosmetically acceptable scar. More than one surgeon may work together to achieve this, including a plastic surgeon.

Sentinel Lymph Node Biopsy 

If the original melanoma biopsy indicates certain high-risk features on the pathology report, a sentinel lymph node biopsy is performed. This procedure is usually done at the time of the wide local excision. During a sentinel lymph node biopsy, a radioactive tracer and a dye are injected into the site of the primary melanoma. These agents are then traced to the “draining” lymph node basin. A small incision is made into the area where these two agents traveled, and the one or several lymph nodes that are marked are removed. They are later examined under a microscope to determine if any melanoma cells are detected. 

If no melanoma cells are found, no further surgical intervention is performed. If this lymph node(s) does contain melanoma cells, then a second surgery (a “completion” lymph node dissection) to remove additional and potentially involved lymph nodes will be performed. These additional lymph nodes are also evaluated by a pathologist to determine if they contain any melanoma cells. This finding is important in determining the stage of a person’s melanoma.

Check out the non-surgical treatments for Melanoma:Non-Surgical Treatments for Melanoma