III melanoma means that cancer cells have spread into skin, lymph vessels, or lymph glands close to the melanoma. The melanoma, however, has not spread further to distant sites within your body.
III can be subdivided into stages IIIA, IIIB, IIIC and IIID
IIIA means all the following:
IIIB means one of the following:
There is no sign of the primary melanoma AND:
The melanoma is no more than 4mm thick. It might or might not be ulcerated AND:
IIIC melanoma – there are additional higher risk features identified such as satellite or more lymph nodes involved or surrounding tissues
IIIC means one of the following:
There is no sign of the primary melanoma AND:
The melanoma may or may not be ulcerated AND:
IIID means the following:
The melanoma is thicker than 4mm and is ulcerated AND:
You should be cared for by a Specialist Skin Multidisciplinary Team (SSMDT), which includes a(skin doctor), a plastic surgeon, an (cancer doctor), a specialist nurse, a pathologist (who reviews the biopsies) and a radiologist (x-ray/scan doctor) and possibly some other types of support staff.
If at the outset the local lymph nodes are known to be involved with melanoma, for example if your doctor can feel them, or after a would be discussed with you. If your melanoma is considered inoperable, you may be considered for or targeted therapy., then you are likely to have IIIA, IIIB, IIIC or IIID melanoma. If the melanoma can be removed with surgery, then
III melanoma include where the melanoma has spread to local areas of skin away from the primary . These are called ‘in-transit’ or ‘satellite ’. In such cases, if the melanoma can not be easily removed, you could be considered for surgery, electrochemotherapy, isolated limb perfusion/infusion or T-VEC (see ‘other options’ on the above or below tab for further information)
The most common place that melanoma skin cancer spreads to is the nearby lymph nodes. If your melanoma is deeper than 1mm (IB to IIC) or if there are additional risk factors, your specialist should offer you a . The lymph nodes are arranged like a bunch of grapes, the allows your doctor to identify the ‘grape’ or node within the bunch and then remove it for analysis. This node is the most likely to be affected by your melanoma. The procedure has two parts; the first occurs in the nuclear medicine department where a safe radioactive dye is injected around your melanoma or scar where your melanoma was, the dye travels in lymphatic channels to where the lymph nodes are, several marks are then drawn on the skin. The second part takes place in the operating theatre, when you are asleep. A blue dye is now injected around the melanoma or scar where your melanoma was and the combination of the radioactivity and the blue staining allows your surgeon to identify the ‘grape(s)’ in the bunch of lymph nodes. This node(s) is removed at the same time as you have the of tissue around your melanoma. The blue dye has been used for over 20 years and is accepted practice worldwide. A few patients may have a bad reaction to the blue dye (anaphylaxis) – similar to the reaction some people have to bee stings or nut allergies, and they would need to stay in hospital at least overnight. Generally, this procedure is completed in one day.
The Sentinel Node adjuvant therapy which may improve their survival. This is the main reason why patients choose to have this procedure in addition to a ., if positive, removes the node(s) which will contain small numbers of cells. This prevents these cells from growing and spreading to other lymph nodes in the area. If you have a positive , you will be considered for
A positive node is found in about 20% (1 in 5) who are offered the procedure. If you are one of the 20% who have a melanoma deposit in your, but do not have a sentinel node , then at some time during your follow up, either you or your doctor will feel a lump, where the lymph nodes are. The few cells that would have been found had you had a sentinel node , will have grown such that they form a lump which you can feel. For the 80% of people who do not have any melanoma in their (s) and would have had a negative sentinel node , then the majority will not detect this lump. It is important to know that even if your sentinel node is negative, in a small number or patients (~ 3-4%) the melanoma will come back in a different . That is why even if you have a negative sentinel node, you are likely to be followed up for 5 years.
Most people are able to go home on the same day of their surgery, but general anaesthesia an affect your co-ordination and concentration, so you’ll need to avoid driving or drinking alcohol for 24-48 hours afterwards. Simple pain relief is usually all that is needed (paracetamol). Most people will need around a week off work, although this will vary depending on the area your melanoma was removed from and the type of reconstruction required to repair the wound. You are likely to need to either see your local practice nurse or return to the dressing clinic in the hospital where you had your surgery for the first dressing change. Any further dressing changes will be discussed with you then.
The wounds will take several weeks to settle and at least 9 months or so for the scars to soften and settle. The final cosmetic outcome will depend upon what type of reconstruction has been needed for your surgery, how you heal, whether there were any problems during the healing phase, other medical conditions you have and if you are a smoker. Generally, most people are not troubled by their scars.
might include pain, bruising and swelling in the area where you’ve had the procedure. The blue dye will make your urine look blue or green for the next couple of days. This is harmless. There is also a risk of an allergic reaction to the dye, an infection in the wound but these risks are low. There will be a collection of fluid in the area (seoma) but this generally settles, there could be a longer-term collection of fluid in your arms or legs ( ), but this is rare when only one or two lymph nodes are removed. As with any operation, there is also risk of nerve injury and adverse reaction to anaesthesia. Your surgeon will be able to discuss the risks of the procedure in your particular situation.
More information on here.can be found
This will not be offered routinely to any patients as there is no evidence that patients lived longer after having this procedure. There will be some circumstances where your doctor still feels that this is the best treatment option for you and the advantages and disadvantages of this will be discussed with you.
If the melanoma has been found to be in the sentinel, a completion dissection is a further operation to remove the other nodes in the same area, in case they are also cancerous. A similar operation may be carried out if at some time you develop a lump in one of your lymph nodes that can be felt and the node is shown to be involved with melanoma. This operation is usually carried out under general anaesthetic.
removal is a major surgical procedure, but the impact varies according to which lymph nodes are removed. After the operation, you may experience pain, swelling and bruising of the area operated on, and some numbness, stiffness and reduced movement. These would usually be temporary. Possible complications include infection and a build-up of fluid in the area of the operation. You will remain at an increased risk of for the rest of your life. The majority of people experience some degree of and for many this requires control of the through elastic sleeves or stockings, exercise and massage.
More information on here.removal (also known as clearance or lymphadenectomy) can be found
is any additional treatment that is given after your melanoma has been surgically removed and no visible melanoma has been left behind or can be seen on a scan. The aim of is to try to stop the melanoma from returning after your operation. It may be, however, that your melanoma will not return without further , however, there is always a risk that your III melanoma could return. Currently, we can’t predict which patients require to ensure they are given the best chance of an overall cure. You and the will need to consider the possibility of preventing the melanoma from returning against the potential of the .
In order to know whether anwill increase the chance of patients being ‘cured’ of their melanoma, it is important to follow-up patients for some years after their treatment. We currently don’t have such a long follow-up of all patients, however, we do have evidence that there is a reduction in the local and distant recurrence of the melanoma returning and some early evidence of an improvement in cure rates. It is very much thought that the reduction in local recurrence is linked to cure. There are three treatment options that have been assessed and are approved in the UK.
The effect ofon your day-to-day life will depend on the type of treatment you are receiving and a number of other factors, including your general health and any or complications you might experience. Treatment is for a year for all of the treatment options; one treatment is an oral regimen and the other two are given intravenously (via a drip) usually in hospital. Some people may carry on almost as normal, whilst others may feel quite unwell and unable to work or socialise during their treatment. It is important that you discuss the balance of the side-effects with the benefits of treatment with your .
For further information, please see individual treatment options below:
Many view taking part in aas a very positive experience. Some of the benefits include:
Often studies are randomised, so you will not know whether you are receiving the new or the standard treatment. Some research has shown that taking part in a trial improves long-term survival, even if you do not have the drug/procedure being tested. The reasons for this are not clear, however it has been suggested that hospitals which undertake medical research provide better treatment.
You also need to consider that new treatments are not always better than standard treatments. The new drug or treatment might not work for you and sometimes there are unexpected.
Many trials compare new treatments with standard treatments, you may be selected to receive either the new treatment or the standard treatment. So, by agreeing to be in a trial, it does not necessarily mean you will receive the new drug being tested.
You may be eligible to take part in a trial. They have strict criteria for joining them to make sure that the results can be relied upon by comparing like with like, and not all treatment centres are involved in trials. Yourshould know what is possible, but sometimes you may need to ask specifically about clinical trials.
You might want to ask:
You may also be asked to take part in research studies, for example into your wellbeing, which may involve taking part in interviews and surveys.
Remember, if you are suitable, it is your decision whether or not to join a.
The following information should be used as part of a discussion with your medical team about the most appropriate treatment for your melanoma. Patients should also be aware that they may not be suitable for all treatments for good reasons. There may also be variation in access to some of these due to regional service variation and limited clinical evidence.
Not everyone withIII or IV melanoma is suitable for surgery – it depends where your melanoma has spread to, and in how many places you now have tumours. Your doctor will tell you whether you are suitable for surgery and how complex it is likely to be. They may recommend following surgery with another treatment, such as targeted treatment or . Surgery in this situation is usually considered if there are just one or two areas of melanoma, which have not changed significantly over a period of 3-6 months. It is also important to recognise the consequences of attempting surgery; your surgeon will discuss the potential benefits versus the risks and consequences of any planned surgery with you.
Risks andwill vary, but all surgery carries risks. Depending on the location, size and number of secondary tumours, you may risk infection, bleeding and blood clots. You may be in pain afterwards, but you will be given medication to help alleviate this. Other will depend on the location of the secondary tumours.
More information on surgery to treat melanoma that has spread to other parts of the body (or ‘metastasised’) is available here.
This is a method of deliveringdirectly into a limb that is used to control melanoma that has come back in a limb. It is given under general anaesthetic and you will stay in hospital for 7 to 10 days usually. A limb perfusion/infusion objective is to provide control of the disease in the limb, either by removing the melanoma or slowing its rate of growth. It is generally considered when the melanoma is limited to a limb, rather than present in many sites.
More information on isolated limb perfusion/infusion is available here
of isolated limb perfusion/infusion usually only affect the treated limb and might include: pain and stiffness, swelling and redness, blisters and peeling, risk of infection, hair loss, nail changes and . There is a small risk to the viability of the limb requiring further surgery or possibly even amputation.
Talimogene laherparepvec (or T-VEC) is a genetically modified virus that is designed to infect and kill melanoma cells. It has to be injected directly into tumours, so is only suitable for people who have lumps that can be felt (e.g. skin lumps or lymph nodes) with no disease in internal organs. It is considered when surgery is not an option. Ultrasound guidance may be needed to make the injection safer. The virus helps to stimulate the body’s own immune system to potentially remove the melanoma.
T-VEC is injected directly into your(s). After the initial treatment, a second dose is given three weeks later with additional doses given every two weeks for at least six months, until there are no remaining injectable tumours to treat or other treatment is required.
You should keep the injection site covered for 48 hours after treatment, and discard dressings in the bin provided by the hospital.
More information on TVEC can be found here
Tiredness, chills, fever, rashes, feeling sick, flu-like symptoms and pain at the injection site.
This is a procedure which involves injection of a drug (bleomycin – adrug) either into the body or just into the melanoma itself. The drug itself is too big to get inside the melanoma cell, so an electrical current is needed to open the cell gates (similar to house electric gates, needing a switch to open them, before the car drives in). This treatment is not limited to just the limbs and can be considered for skin recurrences anywhere. Bleomycin destroys the cancers cells it gets into and so can help control the melanoma and may remove it altogether, but the treatment may need repeating. Depending upon your general health, this treatment option may be suitable for you.
Ablation (burning of melanoma recurrences), using either a laser, or electrical current can be used to treat small melanoma that come back in the same area. This would be done under either a(you would be given a to numb the area beforehand, but you still may feel some discomfort in the skin during the treatment) or general anaesthetic if there is a large area to treat.
More information on electrochemotherapy can be found here
Pain, nausea and skin changes. Bleomycin may cause scarring on the lungs, so you will need to see anto discuss the risks.
Once you been treated forIII melanoma you will be followed up on a regular basis, although the length and frequency of this will be decided between you and your medical team. Following diagnosis of III melanoma, most patients will be seen around every three months over a period of three years, around every six months for a further two years and then on an annual basis up to ten years after diagnosis. Your medical team will carry out examinations to check if the melanoma has spread further. You may also be offered scans (for example CT scans or PET/CT scans) to check for any spread of the cancer. It is important that patients that have been diagnosed with III melanoma are aware of the symptoms to look out for that might indicate the return of melanoma. If in doubt, they should contact their specialist nurse or other key worker.
If you have any concerns or worries please contact our Helpline, which is manned by skin cancer nurses from 1pm – 2pm and 7pm – 9pm Monday to Friday (except bank holidays) and 7pm – 9pm Sunday.
There are lots of sources of support and advice for people with melanoma and other types of cancer. If you speak to your professional about your needs – whether they be emotional, social, financial or practical – they can refer you to an appropriate key worker who can help you to find the support you need. For example, if you are struggling with household chores because you have been affected by your melanoma (e.g. when you’re recovering from an operation), social services might pay for someone to visit to help you out.
The biggest cancer charities in the UK are Cancer Research UK and Macmillan Cancer Support. Both have lots of information on their websites about coping with cancer, along with online communities where you can discuss your treatment with other people. Macmillan also has a phone line and provides face-to-face and financial support to people with cancer and their families.
Melanoma Focus is a national charity dedicated to providing a comprehensive source of information for the public and professionals, as well as lobbying, supporting education and funding research about melanoma. Melanoma Focus also has a helpline, manned by skin cancer nurses, which can be found here.
Melanoma UK, The Myfanwy Townsend Research Fund and the Karen Clifford Skin Cancer Charity (Skcin) are also charities that provide support to melanoma patients, as well as fundraising and raising awareness of melanoma among the public and politicians.
With centres based in the grounds of 21 major NHS cancer hospitals across the UK, Maggie’s provides free practical, emotional and social support to people with cancer, as well as their families and friends. Centres without Maggie’s will have other support options in place which your clinical team will be able to tell you about.