What is the treatment for melanoma

The treatment depends on the stage.

• Stage one. A small operation to cut out the tumour (the biopsy or wide local excision described above) is usually all the treatment that is needed. This is likely to clear all the cancer cells. Following the treatment you will normally be checked from time to time to see that all is well.
• Stage two. Treatment is similar to stage one melanomas - that is a small operation is usually the main treatment. The area of skin removed will be larger than for stage one and may require a skin graft to cover the wound. Depending on the thickness of the primary tumour, you may also be offered adjuvant drug treatment (see below).
• Stage three. You will normally be offered more extensive surgery. This will usually be to remove all the local lymph nodes if the sentinal node biopsy showed cancer cells, and/or to remove other locally affected areas of skin. This aims to remove all of the cancer cells and prevent them from spreading to other parts of the body. You may also be offered adjuvant drug treatment (see below).
• Stage four. In addition to removing the primary tumour and removing affected lymph nodes, treatment will often include one or more of the following, depending on where the cancer has spread to, and what symptoms you have:
  • Chemotherapy. This is a treatment which uses anti-cancer drugs to kill cancer cells, or stops cancer cells from multiplying.
  • Radiotherapy. This is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.
  • Immunotherapy. This aims to boost the immune system to help to fight cancer.

Adjuvant treatment for stage two or three
Adjuvant means 'in addition to'. It is not clear if treatment with chemotherapy or immunotherapy is useful in addition to surgery for stage two or three. It may be that some undetected cancer cells may have spread in some cases, and adjuvant treatment may deal with these. Trials are in progress to see if the outlook (prognosis) improves for people diagnosed with stage two or three who have adjuvant treatment.

What is the outlook (prognosis)

The outlook depends on the stage. Most cases of stage one melanoma are cured with a minor surgical operation to remove the tumour (described above). Most cases of stage two are also cured by the small operation (but slightly less than stage one).

For stage three there is still a chance of cure, but much less than for stage one or two. People with stage four melanoma (advanced melanoma) are not likely to be cured, but treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

Can melanoma be prevented?

Most skin cancers (non-melanoma and melanoma skin cancers) are caused by excessive exposure to the sun. We should all limit our sun exposure in the summer months (or all year when in hot countries nearer the equator) by:

• Staying indoors or in the shade as much as possible between 11am and 3pm.
• Covering up with clothes and a wide brimmed hat when out in the sunshine.
• Applying sunscreen with a sun protection factor of 15 or more to all exposed areas of skin.

In particular, children should be protected from the sun. Sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor to the developing of skin cancer as an adult. Also, people with a family history of melanoma should take extra care to protect their skin from the sun.

See separate leaflet called 'Skin Cancer - Prevention' for details.

Who gets BCC and SCC skin cancers?

BCCs and SCCs become more common with increasing age. Over 7 in 10 cases occur in people over the age of 60. Over 60,000 people in the UK develop a BCC or SCC each year. (BCC is the most common type of cancer of all.) They are rare in children.

What causes BCC and SCC skin cancers?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. (See separate leaflet called 'What Causes Cancer' for more details.)

Sun damage to skin
The main risk factor which 'damages' skin and can lead to a BCC or SCC is sun damage. About 9 in 10 cases of BCC and SCC are thought to be caused by sun damage. It is the ultraviolet (UV) radiation in the sunshine which does the damage.

People most at risk to skin damage are people with fair skin. In particular, those with skin which always burns and never tans, red or blond hair, green or blue eyes. Dark skinned people rarely develop BCC or SCC as they have more protective melatonin in their skin.

Children's skin is most vulnerable to damage. Sun exposure in childhood is the most damaging. People who give a history of freckling in childhood, or frequent or severe sunburn in childhood are most at risk of developing skin cancer as adults. (The damage to the skin can occur many years before a cancer actually develops.) Also, people who have worked outdoors for much of their life and had long-term exposure to the sun are at risk.

Other risk factors
Other factors which increase the risk of developing an SCC or BCC include the following.

• A family history of skin cancer. This may be related to the fact that you may inherit fair skin which is more easily sun damaged, but other genetic factors may play a part in some cases.
• Using sunbeds or similar tanning machines which emit UV light.
• If you have a solar keratosis (actinic keratosis). This is a small, rough, bump which develops on the skin. It is caused by a lot of exposure to the sun over many years.
• If you have already had a previous skin cancer.
• A diet high in fat and low in vitamins.
• Occassionally, a skin cancer develops on an area of skin which has previously been damaged with a burn, scar, a long-standing sore, persistent inflammation, X-ray exposure, or certain chemicals (such as arsenic, creosote, etc.).
• A weakened immune system. For example, if you take immunosuppresant medication following an organ transplant.
• Some rare inherited disorders are associated with an increased risk such as albinism, xeroderma pigmentosa, Gorlin's syndrome, and Bazex's syndrome.

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