KEYTRUDA for advanced melanoma
What are the treatment options?
The majority of people treated for early stage melanoma have surgery only. For advanced melanoma, radiation treatment, chemotherapy and immunotherapy can also be used (independently, or in combination). The doctor will advise on the best treatment for each individual’s case of melanoma.
Healthcare team
Initially this will include a team of doctors including a dermatologist, surgeon and plastic surgeon. If treatment is required beyond surgery, the team may also include medical oncologists, radiation oncologists, radiation therapists, oncology nurses, dieticians, social workers, physiotherapists and occupational therapists.
Surgery
Early stage melanoma is usually removed in the initial biopsy. More surgery is commonly then undertaken (removing a wider margin of surrounding skin) to ensure that all the melanoma cells have been removed. This is done under local anaesthetic as a day procedure, or it may require a general anaesthetic and hospitalisation. In most cases, the wound can be stitched together and will heal as a straight scar.
Skin grafts
Sometimes a skin graft is needed. This involves taking a layer of skin from another part of the body to cover the wound. The other possibility is a ‘flap’, where the surgeon will close the wound using a nearby flap of skin.
Post operation
People may experience pain or discomfort in the days following the procedure, in which case the doctor will most likely prescribe painkillers. There is a small risk of infection, haematoma (bruising) and scarring following surgery for melanoma. Occasionally, the skin graft fails.
Sentinel node biopsy
If the melanoma is more than 1mm thick, the surgeon may suggest a sentinel node biopsy (the sentinel node is the first lymph node that drains from the area where the melanoma developed). The sentinel node is removed surgically and examined. If melanoma cells are found in the nodes, the entire group of nodes in that area may be removed (Block dissection).
A potential side effect is lymphoedema (swelling in the part of the body drained by the affected lymph nodes). Treatment includes specialised exercise, massage, skin care and a properly fitted support garment or bandage.
Radiation treatment
Radiation treatment uses radiation to kill melanoma cells. It typically involves treatment to the skin and nearby lymph nodes, and aims to shrink the tumour and/or to reduce the likelihood of recurrence. Treatment is highly targeted, so as to minimise harm to normal body tissue.
Side effects depend on the part of the body being treated. Skin reddening (similar to sunburn) may occur. It’s important to follow the advice given by the treatment team.
Chemotherapy
Chemotherapy uses anti-cancer drugs to stop cancer cells from growing and reproducing. The drugs work by killing cells that divide rapidly, one of the main characteristics of cancer cells. Chemotherapy is usually given intravenously, or via tablets. For multiple melanoma nodules in the limb, chemotherapy may be given directly into the limb blood vessel. This is called limb infusion/perfusion. Chemotherapy is occasionally used as palliative treatment.
Side effects are specific to the chemotherapy drug(s) chosen. They may include the risk of infection, nausea, vomiting, lethargy, and hair loss. Generally, these side effects are temporary. The treatment team can advise on how to manage them.
Targeted therapies
Approximately half of all melanomas have a mutation (change) in a gene called the BRAF oncogene that helps drive their growth. Targeted therapies may block the activity of the mutated form of the BRAF protein.
Personalised drug therapy
Recent advances in melanoma treatment target specific abnormalities in cancer cells.
Immunotherapies, such as KEYTRUDA, are being used to treat advanced melanoma, by helping the immune system to detect and fight cancer cells.
KEYTRUDA may be used as a first treatment option when melanoma has spread (advanced stage 3-4 melanoma that has spread and cannot be removed by surgery.)
Palliative treatment for advanced cancer
Palliative treatment focuses on preventing and managing the symptoms of cancer and side effects of treatment. It aims to improve quality of life. GPs, specialists and palliative care teams in hospitals or hospices all provide palliative treatment for people with cancer.
There are many factors involved in making a treatment decision. You will need to talk through your options with your doctor to decide what treatment option is best for you.
How KEYTRUDA works
Questions to ask your doctor
