Treatment overview

Treating melanoma

If the results of your excision biopsy confirm that you have a melanoma, you may be seen by two or more specialists. They will work as part of a multidisciplinary team (MDT). The team may include:

  • dermatologists – doctors who specialise in skin conditions
  • skin cancer nurse specialists
  • plastic surgeons
  • oncologists – doctors who specialise in treating cancer.

The MDT will meet to discuss which treatment plan they feel is best for you. They will consider a number of things, such as your general health, the stage of the melanoma and where it is on your body.

Reducing the risk of the melanoma coming back

Most people diagnosed with melanoma will have surgery after their mole has been removed. This surgery is known as a wide local excision. It is done to make sure that all the melanoma cells in the area where the mole was have been removed. This reduces the chance of the melanoma coming back.

Sometimes, other drug treatments are given after surgery if there is a risk the melanoma could come back. These are called adjuvant treatments. They are usually given as part of a research trial. Your hospital team will let you know if adjuvant treatments are suitable for you.

Treating melanoma that has spread to the lymph nodes

Tests to check the nearby lymph nodes sometimes show that the melanoma has spread to them. If this happens, you will be offered further surgery to remove all the nearby lymph nodes. This is called a lymph node dissection.

The multidisciplinary team (MDT) who planned your wide local excision will also be involved in planning the treatment to remove your lymph nodes. They will meet to discuss the plan of treatment they feel is best for you.

Sometimes further treatments are needed. This may happen if it has not been possible to remove all the lymph nodes, or if your doctor thinks there is a risk that the cancer may come back. Radiotherapy may sometimes be offered after surgery. Radiotherapy is treatment with high-energy x-rays.

If your doctor thinks you will benefit from any drug treatments after your lymph node dissection, they will discuss this with you. These are called adjuvant treatments They are given to reduce the risk of a cancer coming back. You usually have them as part of a research trial. This is because doctors are still trying to find out how effective they are. Your specialist may ask you to think about joining a trial.

Benefits and disadvantages of lymph node removal

It is important to be aware of the benefits and disadvantages of surgery to remove your lymph nodes. You should discuss these with your doctors before your treatment. Your doctor or specialist nurse can help you decide whether to have the nodes removed.

Benefits

In many cases, surgery to remove your lymph nodes can help control the local spread and growth of the melanoma. This is especially true if cancer has been found in your lymph nodes because they were swollen and you had an ultrasound or a fine needle aspiration (FNA). However, it is less clear if surgery to remove all the nodes will be helpful if cancer has been found in one lymph node following a sentinel lymph node biopsy (SLNB).

The National Institute for Health and Care Excellence (NICE) has produced guidelines about having lymph nodes removed. They list the possible advantages of a lymph node dissection following a SLNB. The possible advantages of removing the nodes are that:

  • it reduces the risk of the cancer coming back in the same part of the body
  • it is safer and less complicated than waiting until cancer develops in the nodes and then removing them
  • it means that you may be able to take part in clinical trials of new treatments that are not available to people who have not had their nodes removed.

Your doctor will be able to discuss these with you.

Disadvantages

Lymph node dissection is a big operation that will leave a scar on your skin. The scar will become less noticeable with time. You may want to discuss with your doctor and nurse what the scar may look like after surgery, and any other possible disadvantages of surgery.

The guidelines about lymph node dissection also list some possible disadvantages of having surgery to remove all the lymph nodes:

Removing the lymph nodes can sometimes lead to lymphoedema. This is a swelling of an arm, leg or other part of your body, depending on which lymph nodes were removed. There are ways you can help lower your risk of lymphoedema or reduce its severity if it does develop.

In four out of five people, the cancer will not develop in the remaining nodes. So you may not gain any advantage by having an operation to remove them.

There is no evidence that people who have the nodes removed live longer than people who do not.

Even if you do have the lymph nodes removed, there is still a risk that the melanoma may come back again. This will depend on the number of the lymph nodes affected by cancer. Your doctor will be able to discuss this with you.

We have more information about making treatment decisions.

Giving consent

Before you have any treatment, your doctor will explain its aims. They will ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment.

No medical treatment can be given without your consent.

Before you are asked to sign the form, you should be given full information about:

  • the type and extent of the treatment
  • its advantages and disadvantages
  • any significant risks or side effects
  • any other treatments that may be available.

If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.

It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion.

You may also find it useful to write a list of questions before your appointment.

People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.

Second opinion

Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you. You may also find it helpful to have a list of questions ready so that you can make sure your concerns are covered during the discussion.

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