Treatment

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Sentinel Lymph Node Biopsy

A diagnostic procedure, called gamma-probe-guided lymphatic mapping and sentinel lymph node biopsy, also may be performed to determine whether melanoma cells have spread beyond the primary tumor. In this procedure, a radiolabeled material is injected near the tumor site, where lymph fluid will carry it to the "sentinel" node -- the first lymph node to which cancer cells are likely to spread from the primary tumor. The sentinel node is then removed and examined to determine the presence of melanoma cells. Surgery to remove the affected lymph nodes may be necessary if the biopsy indicates metastasis. However, if there is no evidence that cancer has spread, further surgery on the lymph nodes may be avoided.

Knowledge of the status of the sentinel node is very important in helping to assess the risk of recurrence after treatment of the initial primary tumor.

Melanoma Nomogram Our Melanoma Nomogram is designed to help physicians and patients decide which treatment approach will result in the greatest benefit more

In addition to the status of the sentinel node, thickness, ulceration (the formation of a break on the skin or on the surface of an organ), and other characteristics of the primary melanoma are important considerations in determining the most effective course of therapy following surgery

For patients with melanoma that has spread to nearby lymph nodes or skin, or more broadly to other organs, we offer individualized programs that may combine different treatments such as surgery, chemotherapy, radiation therapy, and immunotherapy. Many of these treatments are available only through clinical trials.

Chemotherapy

Chemotherapy may be used to treat metastatic melanoma, depending on the stage of disease and its location. Chemotherapy is a systemic therapy, given by mouth or injection that travels through the blood to cells throughout the body. Chemotherapy can be quite effective for some melanoma patients and often plays a central role in the treatment plan.

In some cases, systemic exposure to chemotherapy may be avoided using a procedure called isolated limb perfusion, in which blood flow to the affected limb is temporarily stopped with a tourniquet while high doses of chemotherapy drugs are delivered to the limb. Doctors at Memorial Sloan-Kettering are evaluating a less invasive approach, called isolated limb infusion. With blood flow to the arm or leg stopped, catheters attached to a pump are put into an artery and a vein in the limb. This means that blood can be circulated through the pump into the limb. Chemotherapy drugs are then injected into the catheters. [Supporting publication]

Immunotherapy

Immunotherapy is a treatment designed to activate the immune system in fighting cancer. Memorial Sloan-Kettering is conducting several clinical trials to test new immunologic treatments in patients with metastatic melanoma and in patients who are melanoma-free after surgery but at risk for recurrence.

Radiation Therapy

Radiation therapy is another treatment option for advanced melanoma that may be used alone or in combination with other therapies. Stereotactic radiosurgery is an alternative to surgery for melanoma that has metastasized to the brain. This treatment delivers a single, high dose of radiation directly to the tumor.

Our Clinical Trials Find out about new research studies for melanoma more

For patients who have had surgery to remove their melanoma but may be at risk for recurrence, Memorial Sloan-Kettering is developing innovative treatments designed to boost the immune system's ability to fight cancer cells and prolong survival. Our researchers are evaluating the effectiveness of melanoma vaccines and other immunotherapies, such as anti-CTLA4 monoclonal antibody.

Recently, researchers have established that 70 to 90 percent of melanomas have mutations in a metabolic pathway called MAPK. These mutations are responsible for "turning on" the MAPK pathway, which in turn leads to tumor growth. Memorial Sloan-Kettering researchers are testing new drugs designed to turn off this pathway to stop the melanoma from growing.

New melanoma drugs are always in development. Patients should ask their doctor for more information about investigational treatment options offered at Memorial Sloan-Kettering.

For early detection of possible spread of disease before surgery, Memorial Sloan-Kettering researchers are assessing techniques to detect individual melanoma cells that may have broken away from a primary tumor.