I have advanced melanoma: what now?

Introduction

In most cases, surgery to cut out your melanoma is successful and is all that is necessary. However, melanoma can spread to other tissues, resulting in Stage III/IV or advanced melanoma.

If your melanoma has spread to the lymph nodes (Stage III) or other organs of your body (Stage IV), treatment is now much more difficult. A team of specialists – the multidisciplinary team (MDT) – will discuss your case to plan investigations and the most suitable treatment.

Who forms the multidisciplinary team?

Multidisciplinary team members may include:

• A co-ordinator for multidisciplinary meetings (MDM)
• A nurse specialist in melanoma care
• A pathologist – a doctor who specialises in diagnosis of disease by examining tissue
• A radiologist – a doctor who specialises in diagnosis of disease by examining images (e.g. X-rays, ultrasound, CT and MRI scans)
• A dermatologist – a doctor who specialises in diagnosing and treating skin conditions
• A surgical oncologist – a doctor who specialises in surgical procedures in cancer patients. This may be a plastic surgeon or another specialist melanoma surgeon
• A medical oncologist – a doctor who specialises in treating cancer using medications such as chemotherapy, immunotherapy, and targeted therapy
• A radiation oncologist – a doctor who specialises in treating cancer patients using radiation therapy
• Other team members as necessary for special situations or sites

What tests will I need?

What tests are recommended will depend on your symptoms and what the doctors find when they examine you.

• To find out why your lymph nodes are enlarged, cells may be removed using a fine needle (FNA) or by core biopsy, sometimes guided by ultrasound scanning.
• If your doctors are looking for melanoma in other organs, you may have a whole-body PET-CT scan.
• If they are suspicious you may have melanoma in the brain, they may consider a contrast-enhanced MRI of the brain.
• Other tests may include X-rays and standard CT scans.

More surgery may be recommended

If melanoma is found in the lymph nodes, the lymph nodes will be surgically removed. The procedure is called a lymph node dissection or lymphadenectomy. You will usually need to be put to sleep (under general anaesthetic) for this operation.

If you have a single melanoma metastasis in an internal organ, your doctor may recommend surgery to remove it.

Non-surgical options for advanced melanoma

When melanoma has spread more widely to other organs in the body, surgery is usually not an option and medical and radiation treatments are used to treat the cancer.

• Radiation therapy – this uses high-energy rays to kill cancer cells
• Chemotherapy – these are drugs that kill cancer cells
• Immunotherapy – these are drugs that stimulate your body’s own immune system to recognise and destroy cancer cells
• Targeted therapy – these are drugs that target the gene changes that turn normal cells into melanoma cells

Managing the advanced stages of melanoma is a difficult process. It is important that you are actively involved and understand your diagnosis and what treatment options are available. Your care team will be able to answer any questions or concerns and help plan your melanoma treatment.

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