Treating Advanced Stage Melanoma
- Robert Dolan, a 72-year-old grandfather, was diagnosed with a later stage of melanoma (a type of skin cancer) after walking his dog led to a painful and bleeding foot.
- Melanoma is a type of skin cancer that starts in the same cells that give your skin, hair and eyes their color.
- There are treatments for all stages of melanoma, although the cure rate is highest for those in the earlier stages. Treatment options may include surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy.
- Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.
- Targeted drugs block proteins and other substances the cancer needs to grow, while immunotherapy boosts your body's own response to help it fight the cancer better. With so many more choices available, treatment can be tailored to you.
The Greater Manchester man, who works as a foster carer and has provided a home to hundreds of people over the past three decades, received his skin cancer diagnosis back in 2021 after having surgery to remove the lump in his foot, followed by a biopsy revealing he had melanoma.Read More
Expert Melanoma Resources
Speaking to Manchester Evening News in a recent interview about his cancer battle, he said, “I was worried about what would happen to me, but the nurses and doctors took the time to talk to me and helped me deal with my worries. They were so kind and warm.”
Dolan, who now undergoes treatment from his own home, was referring to The Christie hospital, praising the specialist cancer hospital as a “a very happy place with a family atmosphere.”
He explained, “When I moved to the combined treatment last year, the first four cycles were done at the Withington site, then they told me about the ‘at home’ team.”
“Being treated at home feels more personalized. I'm in a familiar environment, and it is more relaxed. The chair I sit in at home is more comfortable than in hospital, and I can have the dogs around me distracting me.”
Dolan added, “It's like having someone put a warm blanket around you when you feel poorly. You feel in very safe hands. I also don't have to worry about driving to Withington [where The Christie hospital is located], finding somewhere to park, and then waiting for my treatment slot to be available. I can't praise the ‘at home’ service enough.”
Dolan, who has since had five treatments, gets an infusion every four weeks but a visiting nurse and enjoys being able to “get on with the rest of my life until the next lot of treatment."
As of recent, Dolan’s PET scan has revealed no progression of the cancer in his lungs, allowing him to be booked for radiotherapy treatment of his lymph nodes.
Learning About Melanoma
Melanoma is a type of skin cancer that starts in the same cells that give your skin, hair and eyes their color. The American Cancer Society estimates that about 99,610 new melanomas will be diagnosed in the United States in 2023
And while the ACS says the risk of melanoma increases as people age with the average age of diagnosis being 65, the disease is not uncommon among those younger than 30. In fact, it's one of the most common cancers in young adults (especially young women).
The disease can develop from an existing mole or appear as a dark or pink growth on the skin even in places on the body that never see the sun. It's also known to be the deadliest form of skin cancer.
“Melanomas are the deadliest type of skin cancer because they have a tendency to spread to other parts of the body,” explains Dr. Anna Pavlick, a medical oncologist with Weill Cornell Medicine who specializes in treating skin cancer.
Ninety percent of melanomas are caused by ultraviolet radiation from the sun. This means excessive time in the sun even as a child puts you at a higher risk.
Once you've been diagnosed with melanoma, your doctor will typically tell you the stage of your melanoma based on how far the cancer has spread. The way that melanoma spreads is a bit different from other cancers. The higher the stage of melanoma, the deeper it has spread into the layers of your skin, and the more serious your cancer is.
Melanoma is known mostly as a cancer of the skin. Melanocytes are the cells of the skin that produce the pigment melanin that colors the skin, hair, and eyes. They can also form moles, which is typically the origin of a melanoma diagnosis.
Melanoma is staged based on how deep the cancer has infiltrated the skin.
- Stage 1: less than 1 mm in depth and easily removed by a dermatologist
- Stage 2: greater than 1mm in depth and removed by a surgical oncologist
- Stage 3: greater than 2 mm or 3 mm in depth and has spread into the lymph nodes
- Stage 4: most advanced stage representing cancer that has spread to other parts of the body
There are treatments for all stages of melanoma, although the cure rate is highest for those in the earlier stages. Treatment options may include surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy.
Later-Stage Melanoma Treatment
Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.
Targeted drugs block proteins and other substances the cancer needs to grow, while immunotherapy boosts your body's own response to help it fight the cancer better. With so many more choices available, treatment can be tailored to you. These therapies are more likely than chemotherapy to control your cancer, but like any treatment they can cause side effects.
Immunotherapy drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) can help some people with this cancer live longer. Whether these drugs are right for you depends on a number of factors, including where the melanoma is and how fast it's spreading. Combining immunotherapy drugs might also extend survival. But again, these treatments have risks that are important to discuss with your doctor.
There's also a vaccine that has been approved by the U.S. Food and Drug Administration for people whose melanoma has spread and can't be removed with surgery. Talimogene laherparepvec (T-VEC) is a modified herpes virus that kills cancer cells when doctors inject it directly into the cancer.
Researchers, including some of SurvivorNet's own experts, are studying other groundbreaking melanoma treatments in clinical trials. Enrolling in one of these studies might give you access to a new treatment before it's available to everyone else.
Once you've finished treatment for melanoma, it can come with a huge sense of relief. Celebrate your successes, but stay vigilant. It is possible for this cancer to come back in the future. Whether your cancer is likely to return may depend on your stage, so screening recommendations vary. If you had early-stage melanoma, you should have a skin exam once every three to six months.
If you had late-stage melanoma, in addition to regular skin exams every three to six months, you may also need imaging scans or blood tests to monitor for signs of recurrence. You should also report any symptoms such as a headache, changes in vision, cough, fatigue, or weight loss to your doctor.
Skin Cancer Prevention
In a previous interview with SurvivorNet, Dr. Dendy Engelman from MDCS Dermatology in New York shared the top five things you can do to avoid skin cancer:
- Avoid sun during peak hours, which is 10 a.m. to 2 p.m.
- Wear a wide brimmed hat and sunglasses to protect the tops of our heads, the tops of our ears and the delicate area around the eye.
- Wear at least SPF 30 sunscreen and make sure to reapply every two hours or after excessive sweating or swimming.
- Have yearly skin checks (with a professional), because it's difficult to evaluate areas all over the body.
- Avoid tanning beds. There are no "good" tanning beds, and they can significantly increase your risk of melanoma.
Paying Attention to Your Skin
Keeping an eye on the moles or growths on your skin is an easy way to keep an eye out for melanoma. Changes to a mole you've had for a while or developing a new growth you don't remembering having on your skin could be signs of this cancer, according to SurvivorNet's experts.
- Asymmetrical moles: “If you drew a line straight down the center of the mole, would the sides match?”
- Borders that are “irregular, jagged, not smooth.” It can also stand for bleeding.
- Colors: “Multiple distinct colors in the mole.”
- Diameter: “Larger than 6mm, about the size of a pencil head eraser.”
- Evolution: “This may be the most important,” she says. “Anything that is changing over time such as gaining color, losing color, painful, itching, hurting, changing shape, etc.”
Spots on our skin are often harmless, but it's still important to keep an eye on them and reach out to your doctor if you see any changes or find a growth anywhere on your skin that looks suspicious.
Contributing: SurvivorNet Staff