The Best Treatment for Recurrent Melanoma

Melanoma is the deadliest form of skin cancer. It is one of the top 10 most common cancers in the United States, with more than 62,000 new cases diagnosed each year and contributing to more than 11,000 deaths each year. Melanoma is occurring more now than in the past, largely due to increased sun exposure and the use of tanning beds, as well as other risk factors.

Screening

• Screening for recurrent melanoma is one of the most important parts of management. Melanoma can spread rapidly, and sometimes symptoms are absent. Therefore, it is important to self-examine the skin to look for anything abnormal and to regularly visit your dermatologist. Many times the best outcomes are achieved if melanoma is caught early.

Sites of Recurrence

• Melanoma can recur in an area close to where the original melanoma was found and removed (called "local recurrence"), on another site of your body at the same time or after the first melanoma was removed (called "second primary"), or at a distant place on the body (termed "metastatic melanoma"). Risk of recurrence depends on thickness of the first (primary) tumor, whether ulceration is seen at the site of the primary tumor, and if there are areas of tumor growth that can be seen surrounding the primary tumor.

Treatment of Local Recurrence

• The best treatment for recurrent melanoma varies based on primary melanoma stage, treatment of the first melanoma, and where the melanoma recurs. For instance, if the melanoma was originally staged as stage IV, more advanced treatment is necessary but probably will not be curative. If the new melanoma is found at the site of the original melanoma or in an isolated area, surgical excision is recommended. Depending on whether one or more lesions are found, biologic therapy or chemotherapy and possibly regional limb perfusion (i.e., when chemotherapy is given only in an arm or leg, not the whole body) may be required. If the lymph nodes are involved, the lymph node is dissected.

Treatment of Metastatic Melanoma

• Unfortunately, recurrent melanoma does not respond to many treatments. However, some chemotherapy and biologic agents have had some success in achieving a response.

  Dacarbazine, a chemotherapy agent, has been used for melanoma for some time. Dacarbazine can be given alone or in combination with other chemotherapy drugs, such as cisplatin, vinblastine or tamoxifen. Temozolomide, a newer chemotherapy drug taken orally, is being studied for recurrent melanoma and has shown some promise.

  Biologic therapy is a newer technique for many types of cancer, including recurrent melanoma. Although in the early stages of investigation, some of these biologic agents have been shown to shrink melanoma. Types of biologic therapy evaluated in melanoma include immunotherapy (interferon, tumor necrosis factor), vaccines, gene therapy (Augmerosen), and monoclonal antibodies (bevacizumab, ipilumumab).