What Are the Treatments for Level 5 Malignant Melanoma?

Melanoma is a cancer of pigment-producing cells in the skin. It's the most dangerous form of skin cancer. If caught early, the survival rate is high. If the disease has progressed further or spread to other organs by the time it's diagnosed, however, it becomes far more difficult to treat successfully. Surgery, chemotherapy, immunotherapy and sometimes radiotherapy are all treatments for level 5 melanoma.

Levels & Staging

• Doctors use a couple different systems to classify a tumor, depending on how far it's progressed at the time of diagnosis. TNM (tumor, node, metastasis) categorizes the cancer by the size of the tumor, the extent to which it's metastasized and the degree to which it's colonized the lymph nodes. The TNM categorization is used to assign a stage, where stage I is the least advanced and stage IV the most advanced. Another common way to classify malignant melanoma is using the Clark level of invasion classification. Level I means the cancer is still confined to the epidermis (the outermost layer of the skin), while level V means the tumor has grown deep into the skin and invaded the subcutaneous tissue, the fatty layer beneath the dermis. The five-year survival rate in Clark level 5 melanomas is estimated at 55 percent, although the Clark level of invasion isn't considered to be an independent predictor of outcome and is generally used in combination with other classifications.

Surgery

• The most common treatment for level V malignant melanoma is surgery to excise the primary tumor. Typically the surgeon will remove a margin of normal skin around the tumor in order to ensure it's completely removed. If the tumor has already spread to the lymph nodes, the surgeon may remove these as well.

Chemotherapy & Immunotherapy

• Chemotherapy is a common treatment for advanced melanoma. In patients with level V tumors, it's often used to help reduce the number of cancer cells in combination with surgery. If the tumor is confined to a limb--for example, to an arm or a leg--and hasn't yet metastasized, some doctors may try a procedure called isolated limb perfusion, in which blood flow from the limb is temporarily restricted with a tourniquet so that the chemotherapy drugs affect only the limb and not other areas of the body. Immunotherapy (also called biotherapy), another approach to treating level V cancer, involves the administration of agents that help boost your immune system so that it can fight the tumor. The side effects are similar to the symptoms of the flu.

Radiotherapy

• If the cancer has already metastasized, doctors may resort to radiotherapy, an approach that uses high-frequency radiation like X-rays to attack the cancer cells. Radiotherapy doesn't seem to be very effective in prolonging survival in patients with metastatic melanoma but can help relieve pain caused by the cancer and reduce tumor size as well.

Clinical Trials

• While level V is more difficult to treat successfully than less advanced Clark invasion levels, one of the most important predictors is whether the disease has already metastasized (invaded other organs of the body). Metastatic melanoma is very difficult to treat successfully with current techniques, although numerous researchers are pursuing a variety of approaches that might result in a more effective treatment. Depending on your condition, you may be eligible to enroll in a clinical trial for one of these experimental therapies. The website ClinicalTrials.gov is a useful resource that provides a searchable database of ongoing clinical trials. A link to the website appears in the resources section below. For more information about clinical trials or about choosing the best treatment, talk to your doctor.