If you have IIIA melanoma, this means your melanoma has travelled to the local lymph nodes following analysis of a. Your doctor may now recommend another operation to remove further lymph nodes in this area known as a Lymphadenectomy or clearance.
If at the outset the local lymph nodes are known to be involved with melanoma, for example if you/your healthcare professional can feel them, or after a scan and a needle, then you are likely to have IIIB or IIIC melanoma. These are also the stages if the melanoma has spread to local areas of skin away from the primary . These are called ‘in-transit’ or ‘satellite ’. If treatment for in-transit metastases is required then you may want to consider the following options:
Isolated limb perfusion/Infusion: 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.
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 .
Laser therapy: carbon dioxide laser therapy can be used to treat small melanoma that come back in the same area by directing a high intensity beam of light at the affected areas of skin. You would be given ato numb the area beforehand, but you still may feel some discomfort in the skin during and after treatment.
After thesurgery, you may be offered , which is the name for treatment for cancer offered after surgery to prevent it from coming back. This is likely to be as part of a . In the UK, at the time of writing this guidance, there is no strong evidence yet to prove that adjuvant treatment stops melanoma from returning or spreading although this situation may change in the future.
and are rarely used for IIIa and IIIb melanoma. For patients with IIIc melanoma which is inoperable, drug treatment and can be considered, as in IV.
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 and a radiologist (x-ray/scan doctor) and possibly some other types of support staff.
The following information should be used as part of a discussion with your healthcare professional about the most appropriate treatment for your melanoma. Patients should also be aware that they may not be suitable for all the diagnostic interventions and treatments outlined below. There may also be variation in access to some of these due to regional service variation and limited clinical evidence.
If the melanoma has been found to be in the sentinel, your doctor may recommend a further operation to remove the other nodes in the same area, in case they are also cancerous.
If at the outset one or more of the local lymph nodes have already been found to be involved with the cancer then ais not necessary and the operation will aim to remove all the nodes in that area.
This operation will be carried out under general anaesthetic.
Removing the remaining lymph nodes after ais unlikely to extend your life. However, it does reduce the risk of the cancer returning to that local area and if further cancerous nodes are found it is likely to reduce the number and size of any deposits compared to leaving them. It is a safer and less complicated operation when carried out before cancer develops in the lymph nodes, and may also give you the option of entering clinical trials. There is an 80% chance that the sentinel node will have removed the only cancerous and that the remaining nodes are normal.
removal is a major surgical procedure, but the impact varies according to which lymph nodes are removed. If the nodes in your armpit or groin are removed, you might experience shoulder or hip stiffness and pain afterwards. You may also experience , in which fluid builds up in the affected arm or leg leading to swelling. If develops it can be improved with the help of exercise regimes and massage-type techniques but will never go away completely.
After the operation, you may experience pain, swelling and bruising of the area operated on, and some numbness, stiffness and reduced movement. Thesewould 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. This can usually be controlled through elastic sleeves or stockings, exercise and massage.
If you choose not to have aclearance then there is a chance that the melanoma may grow in the remaining lymph nodes and this, in turn, could cause problems. For example, impaired drainage.
More information on here.removal (also known as clearance or lymphadenectomy) can be found
You might be offeredeither on its own or as part of a . The aim of is to try to stop the melanoma from returning after your operation. In the UK, at the time of writing this guidance, it is unlikely that you will be offered any drug therapy outside of a as there isn’t any strong evidence at present to suggest that this is successful in reducing the recurrence of melanoma. You and your healthcare professional will need to consider whether the risks and of the medication being tested in such a trial are worth the possibility of preventing the melanoma from returning.
Clinical trials have produced mixed results to date, but there is no single adjuvant therapy with strong evidence for significantly prolonging life expectancy inIII melanoma patients.
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. Some people may carry on almost as normal, whilst others may feel quite unwell and unable to work or socialise during their treatment.
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 healthcare professional. 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 healthcare professionals 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. If you have a 3a or 2c and your team feel that it might be useful, you may also be offered imaging. 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.
There are lots of sources of support and advice for people with melanoma and other types of cancer. If you speak to your healthcare professional about your needs – whether they be emotional, social, financial or practical – they can refer you to an appropriate person who can help you to find the appropriate support. For example, if you are struggling with household chores as a result of 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 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 17 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.