Other Options

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.

Surgery

What is it?

Not everyone with stage III 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 immunotherapy. 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 and side effects

Risks and side effects will 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 side effects 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.

Isolated limb perfusion/infusion

What is it?

This is a method of delivering chemotherapy directly 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

Risks and Side Effects

Side effects 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 lymphoedema. There is a small risk to the viability of the limb requiring further surgery or possibly even amputation.

Talimogene laherparepvec (T-VEC)

What is it?

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 tumour(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

Risks and side effects

Tiredness, chills, fever, rashes, feeling sick, flu-like symptoms and pain at the injection site.

Electrochemotherapy

What is it?

This is a procedure which involves injection of a drug (bleomycin – a chemotherapy drug) 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 local anaesthetic (you would be given a local anaesthetic 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

Risks and side effects

Pain, nausea and skin changes.  Bleomycin may cause scarring on the lungs, so you will need to see an oncologist to discuss the risks.

Values you may wish to consider during treatment

    • Is the most important thing to you having treatment that gives you the best chance of curing your melanoma?
    • How prepared are you to have a treatment that has a potential risk of causing serious side effects or complications?
    • How prepared are you to have a year of treatment?
    • Is it important to you whether you have oral treatment or treatment in hospital?
    • How much time are you prepared to spend in hospital having treatment?
    • How much do you want to avoid having a visible scar after treatment?
    • How important is it to you to know everything about your risk of future melanoma?
    • How important is it to you to maintain living an active lifestyle, taking into account your daily activities and hobbies?
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