Melanoma, the deadliest form of skin cancer 1, arises from melanocytes, specialized cells responsible for producing melanin. While early detection and treatment are crucial, advanced cases present significant challenges. This report explores both traditional and alternative treatments for melanoma, examining their potential benefits and risks.
Traditional Melanoma Treatments
Traditional melanoma treatments primarily involve surgery, radiation therapy, and systemic therapies.
Surgery
Surgery is often the first line of treatment for melanoma2. The specific surgical approach depends on factors such as the size, depth, and location of the melanoma2. Wide local excision, a common surgical procedure, is employed for melanoma tumors that have not spread to other areas4. This procedure involves removing the entire tumor along with a margin of healthy tissue surrounding it to ensure complete removal5. In many cases of early-stage melanoma, wide local excision can be curative5. If the melanoma has spread to nearby lymph nodes, a procedure known as lymph node dissection, or lymphadenectomy, may be performed6. This involves removing the affected lymph nodes to assess the extent of cancer spread and mitigate the risk of metastasis6.
Radiation Therapy
Radiation therapy utilizes high-energy beams, such as X-rays, to destroy cancer cells by damaging their DNA7. While not always the primary treatment for melanoma on the skin, radiation therapy can be valuable in specific situations8. For instance, it may be used after surgery to prevent recurrence, in combination with other therapies to enhance treatment response, or to alleviate symptoms caused by the spread of melanoma to other parts of the body7. Intensity-modulated radiation therapy (IMRT) is an advanced technique that allows for precise radiation delivery, minimizing damage to healthy tissue7. Superficial forms of radiation therapy, where radiation penetrates only a short distance below the surface, are commonly used for skin cancer9. For melanoma that has spread to the brain, stereotactic radiosurgery (SRS) delivers a high dose of radiation to the tumor without harming surrounding brain tissue10.
Systemic Therapies
Systemic therapies involve medications that travel throughout the body to target cancer cells. These include immunotherapy, targeted therapy, and chemotherapy.
Immunotherapy
Immunotherapy is now recommended as the first treatment for most patients diagnosed with advanced melanoma due to the potential for long-lasting remissions11. This approach harnesses the body’s immune system to fight cancer12. Immune checkpoint inhibitors, such as ipilimumab, nivolumab, and pembrolizumab, have shown remarkable success in treating advanced melanoma13. These drugs work by blocking proteins that prevent the immune system from attacking cancer cells, thereby enabling the body to mount a more effective anti-tumor response12.
Targeted Therapy
Targeted therapy focuses on specific molecules within cancer cells to inhibit their growth and spread15. Drugs like vemurafenib, dabrafenib, and trametinib target genetic mutations commonly found in melanoma cells15. Targeted therapies can be used alone or in combination with other treatments15.
Chemotherapy
Chemotherapy utilizes drugs to destroy cancer cells or prevent them from dividing15. While chemotherapy is less frequently used for advanced melanoma due to the emergence of newer therapies, it can be helpful in certain situations, such as shrinking tumors that have spread to distant sites or treating melanoma in an arm or leg through Isolated Limb Infusion (ILI)15.
| Therapy Type | Mechanism | Examples | Benefits/Risks |
|---|---|---|---|
| Immunotherapy | Harnesses the body’s immune system to fight cancer | Ipilimumab, nivolumab, pembrolizumab | Can stimulate long-lasting remissions; may cause immune-related side effects |
| Targeted therapy | Focuses on specific molecules within cancer cells | Vemurafenib, dabrafenib, trametinib | Can inhibit tumor growth and spread; may cause skin rashes and other side effects |
| Chemotherapy | Uses drugs to destroy cancer cells or prevent them from dividing | Dacarbazine, temozolomide | Can shrink tumors; may cause low blood counts and other side effects |
Alternative Melanoma Treatments
Alternative treatments for melanoma encompass a variety of approaches that fall outside the realm of conventional medicine. These include vitamin C and other complementary therapies.
Vitamin C
Studies have shown promising results for vitamin C as a potential anti-melanoma agent in preclinical settings18. Evidence indicates that high concentrations of vitamin C can induce cell death in melanoma cells19. One study found that vitamin C increased DNA damage and cell death rates in melanoma cells while protecting normal cells20. However, more research is needed to determine the optimal dosage and delivery method of vitamin C for melanoma treatment19.
Complementary Therapies
Complementary therapies are used alongside conventional medical treatments to support overall well-being21. These therapies may include:
- Nutrition therapy: Focuses on consuming a balanced diet rich in antioxidants and fiber to support the immune system and overall health22. For example, incorporating a variety of fruits and vegetables can provide essential antioxidants, while increasing fiber intake may enhance the response to immunotherapy23.
- Herbal medicine: Utilizes plant-based remedies, such as green tea, which may have anti-cancer properties due to their high antioxidant content24.
- Acupuncture and acupressure: Aim to alleviate pain and promote relaxation by stimulating specific points on the body22.
- Massage and physical therapy: Help manage pain, improve mobility, and maintain physical function22. If melanoma has spread to the lymph nodes, strength training and stretching exercises can be particularly beneficial24.
- Hydrotherapy: Employs warm or cool water, such as steam baths or ice packs, to reduce pain and inflammation24. Warm water can relax muscles, while ice can reduce inflammation by constricting blood vessels24.
- Mind-body therapies: Include practices like meditation and yoga to reduce stress, improve emotional well-being, and enhance quality of life22. Yoga, with its focus on breathing and physical postures, can improve cardiovascular health and reduce stress24. Meditation can help individuals examine the relationship between emotional, mental, and behavioral factors in their health, promoting relaxation and reducing anxiety24.
It is crucial to consult with a healthcare professional before using any complementary therapies, as some may interfere with conventional treatments or have potential risks22. For example, certain botanical agents, phytochemicals, and herbal formulas may have unintended interactions with conventional cancer treatments25.
Research and Clinical Trials
Ongoing research plays a vital role in advancing melanoma treatment. Clinical trials are essential for evaluating the safety and efficacy of new therapies26. Recent research has focused on:
- Combining immunotherapy with other treatments: Studies are exploring the benefits of combining immunotherapy with targeted therapies or cellular therapies to enhance treatment response and overcome resistance27.
- Developing new targeted therapies: Researchers are investigating new drugs that target specific genetic mutations or pathways involved in melanoma development to provide more personalized and effective treatment options29.
- Improving TIL therapy: TIL therapy, which involves isolating and expanding tumor-infiltrating lymphocytes (TIL), has shown promise in treating advanced melanoma, and research is ongoing to optimize this approach and expand its applications29.
- Addressing treatment resistance: Studies are exploring ways to overcome resistance to immunotherapy and targeted therapies to improve long-term outcomes for patients30.
Benefits and Risks of Melanoma Treatments
Each melanoma treatment option has potential benefits and risks.
Benefits
- Surgery: Can be curative for early-stage melanoma, removes visible tumors, and provides tissue for diagnosis and staging31.
- Radiation therapy: Can shrink tumors, relieve symptoms, and prevent recurrence8.
- Immunotherapy: Can stimulate the body’s immune system to fight melanoma, leading to long-lasting remissions12.
- Targeted therapy: Can inhibit the growth and spread of melanoma by targeting specific molecules within cancer cells15.
- Complementary therapies: May improve quality of life, reduce stress, and support overall well-being21.
Risks
- Surgery: May cause scarring, pain, and infection32.
- Radiation therapy: May cause skin irritation, fatigue, and hair loss8.
- Immunotherapy: May cause immune-related side effects, such as inflammation of organs33.
- Targeted therapy: May cause skin rashes, diarrhea, and other side effects33.
- Complementary therapies: May interact with conventional treatments or have unknown side effects21.
Cost and Accessibility
The cost of melanoma treatment can vary significantly depending on the type of treatment, stage of cancer, and individual circumstances36. Average treatment costs range from $1,732 for stage I to $56,059 for stage IV36. The overall annual cost for treating melanoma has grown faster than the costs for all other cancers combined, and the annual cost of treating new patients with melanoma is projected to be $1.6 billion by 203037. Studies have also shown an increase in melanoma healthcare costs, particularly for stage III and IV disease, with a sixfold to ninefold increase in healthcare costs per person for these stages between 2007-2012 and 2018-201938. Immunotherapy and targeted therapies tend to be more expensive than traditional treatments39. Despite its effectiveness, immunotherapy for melanoma is expensive and faces accessibility challenges40.
Accessibility to melanoma treatment can also be a concern, particularly for individuals living in rural areas or those with limited access to specialized medical centers41. Factors such as socioeconomic status, insurance coverage, and education level can also influence access to care40.
New Developments and Ongoing Research
New developments in melanoma treatment include:
- FDA approval of lifileucel (Amtagvi): A TIL therapy for advanced melanoma that has recurred after treatment with other therapies, such as PD-1 blocking antibodies and BRAF inhibitors42. This represents a significant advancement in cellular therapy for solid tumors.
- FDA approval of tebentafusp (Kimmtrak): A bispecific fusion protein for metastatic uveal melanoma, a rare form of melanoma that originates in the eye and is often fatal when it spreads29. This new treatment option offers hope for patients with this aggressive form of the disease.
- Combination of nivolumab and relatlimab (Opdualag): An immunotherapy combination that targets two immune checkpoints, PD-1 and LAG-3, to enhance the immune response against melanoma43.
Ongoing research continues to explore new treatment strategies, improve existing therapies, and address challenges such as treatment resistance and accessibility. Research is also focusing on gene expression patterns in melanoma cells to predict the likelihood of spread or recurrence in early-stage melanomas30.
Conclusion
Melanoma treatment has evolved significantly in recent years, with the emergence of innovative therapies that have improved outcomes for many patients. Today, 1 in 2 patients with metastatic melanoma are alive 5 years after diagnosis when treated with combination immunotherapy, and over 1 in 3 patients are alive following years of combination BRAF/MEK targeted therapy or single-agent PD-1 blockade44. Traditional treatments, such as surgery, radiation therapy, and systemic therapies, remain the mainstay of melanoma care. Alternative approaches, including vitamin C and complementary therapies, may offer additional benefits but should be used in consultation with a healthcare professional. Ongoing research and clinical trials are crucial for advancing our understanding of melanoma and developing new and more effective treatments. Researchers are actively investigating new immune checkpoint inhibitors, adoptive cell therapies, and ways to overcome treatment resistance, offering hope for continued progress in the fight against melanoma30.
Works cited
1. Melanoma Treatment – NCI, accessed January 15, 2025, https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq
2. Melanoma Treatments – UT Southwestern Medical Center, accessed January 15, 2025, https://utswmed.org/conditions-treatments/melanoma/melanoma-treatments/
3. Melanoma – Diagnosis and treatment – Mayo Clinic, accessed January 15, 2025, https://www.mayoclinic.org/diseases-conditions/melanoma/diagnosis-treatment/drc-20374888
4. Melanoma Surgery | Mohs and Excision Procedures – Penn Medicine, accessed January 15, 2025, https://www.pennmedicine.org/cancer/types-of-cancer/melanoma/melanoma-treatments/melanoma-surgery
5. Wide Local Excision for Melanoma, accessed January 15, 2025, https://www.curemelanoma.org/patient-eng/melanoma-treatment/surgery/wide-local-excision
6. Melanoma Surgery – Moffitt Cancer Center, accessed January 15, 2025, https://www.moffitt.org/cancers/melanoma/treatment/surgery/
7. Radiation Therapy for Melanoma | Memorial Sloan Kettering Cancer Center, accessed January 15, 2025, https://www.mskcc.org/cancer-care/types/melanoma/treatment/radiation-therapy-melanoma
8. Radiation Therapy for Melanoma Skin Cancer, accessed January 15, 2025, https://www.cancer.org/cancer/types/melanoma-skin-cancer/treating/radiation-therapy.html
9. Skin Cancer Treatment – Radiation Oncology – UCLA Health, accessed January 15, 2025, https://www.uclahealth.org/cancer/cancer-services/radonc/treatments/skin-cancer
10. Radiotherapy for melanoma | Macmillan Cancer Support, accessed January 15, 2025, https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/radiotherapy-for-melanoma
11. New Research in Melanoma | Johns Hopkins Kimmel Cancer Center, accessed January 15, 2025, https://www.hopkinsmedicine.org/kimmel-cancer-center/cancers-we-treat/melanoma/research/new-research
12. Melanoma Treatment – The Skin Cancer Foundation, accessed January 15, 2025, https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-treatments/
13. pmc.ncbi.nlm.nih.gov, accessed January 15, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6726851/#:~:text=Currently%2C%20the%20US%20Food%20and,therapy%20with%20ipilimumab%20and%20nivolumab.
14. Systemic Therapy for Melanoma: ASCO Guideline | Journal of Clinical Oncology, accessed January 15, 2025, https://ascopubs.org/doi/10.1200/JCO.20.00198
15. Treatment Options for Melanoma Patients, accessed January 15, 2025, https://www.curemelanoma.org/patient-eng/melanoma-treatment
16. Systemic Therapy for Melanoma | Fox Chase Cancer Center – Philadelphia PA, accessed January 15, 2025, https://www.foxchase.org/clinical-care/conditions/melanoma/diagnosis-treatment/systemic-therapy
17. Treatment of Melanoma Skin Cancer, by Stage – American Cancer Society, accessed January 15, 2025, https://www.cancer.org/cancer/types/melanoma-skin-cancer/treating/by-stage.html
18. pmc.ncbi.nlm.nih.gov, accessed January 15, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6732962/#:~:text=Vitamin%20C%20potently%20suppressed%20human,the%20presence%20of%20vitamin%20C.
19. Vitamin C at high concentrations induces cytotoxicity in malignant melanoma but promotes tumor growth at low concentrations – PubMed, accessed January 15, 2025, https://pubmed.ncbi.nlm.nih.gov/28370562/
20. New study shows vitamin C boosts DNA damage and cell death in …, accessed January 15, 2025, https://www.usf.edu/arts-sciences/chronicles/2024/new-study-shows-vitamin-c-boosts-dna-damage-and-cell-death-in-melanoma-cells.aspx
21. How is melanoma skin cancer treated? – American Cancer Society, accessed January 15, 2025, https://www.cancer.org/cancer/types/melanoma-skin-cancer/treating.html
22. Alternative treatments for melanoma: Effectiveness and more, accessed January 15, 2025, https://www.medicalnewstoday.com/articles/alternative-treatments-for-melanoma
23. Complementary Treatments for Stage 4 Melanoma – HealthCentral, accessed January 15, 2025, https://www.healthcentral.com/slideshow/complementary-and-alternative-treatments-stage-4-melanoma
24. Alternative Treatments for Melanoma | Healthline, accessed January 15, 2025, https://www.healthline.com/health/melanoma-alternative-treatments
25. Complementary and alternative therapies in skin cancer: A literature review of biologically active compounds – PMC, accessed January 15, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10481428/
26. Clinical Trials – Melanoma Research Alliance, accessed January 15, 2025, https://www.curemelanoma.org/patient-eng/clinical-trial-locator
27. Melanoma and Other Skin Cancers Research Results and Study Updates – NCI, accessed January 15, 2025, https://www.cancer.gov/types/skin/research/articles
28. Clinical Trials to Watch: September 2024 – Melanoma Research Alliance, accessed January 15, 2025, https://www.curemelanoma.org/blog/article/clinical-trials-to-watch-september-2024
29. New Treatments Improving Prognosis for Stage 4 Melanoma Patients, accessed January 15, 2025, https://www.mskcc.org/news/changing-melanoma-landscape-how-research-has-improved-outlook-people-advanced-disease
30. Melanoma Skin Cancer Research – American Cancer Society, accessed January 15, 2025, https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/new-research.html
31. premierdermatologyatlanta.com, accessed January 15, 2025, https://premierdermatologyatlanta.com/benefits-melanoma-treatment-atlanta/
32. Surgery to remove melanoma skin cancer, accessed January 15, 2025, https://www.cancerresearchuk.org/about-cancer/melanoma/treatment/surgery/surgery-remove-melanoma
33. Side Effects – Melanoma – SITC connectED, accessed January 15, 2025, https://www.sitcancer.org/connectedold/p/patient/resources/melanoma-guide/side-effects
36. helphopelive.org, accessed January 15, 2025, https://helphopelive.org/skin-cancer-financial-assistance/#:~:text=Skin%20Cancer%20Treatment%20Cost,to%20%2456%2C059%20for%20stage%20IV.
37. Skin Cancer Financial Assistance – Help Hope Live, accessed January 15, 2025, https://helphopelive.org/skin-cancer-financial-assistance/
38. Study finds melanoma treatment costs have increased, but so has survival – Healio, accessed January 15, 2025, https://www.healio.com/news/dermatology/20230912/study-finds-melanoma-treatment-costs-have-increased-but-so-has-survival
39. Immunotherapies for Melanoma: Worth the Cost? – HMP Global Learning Network, accessed January 15, 2025, https://www.hmpgloballearningnetwork.com/site/frmc/article/immunotherapies-melanoma-worth-cost
40. Not all treatments created equal: Identifying barriers to immunotherapy for melanoma, accessed January 15, 2025, https://www.healio.com/news/dermatology/20240513/not-all-treatments-created-equal-identifying-barriers-to-immunotherapy-for-melanoma
41. Current Challenges in Access to Melanoma Care: A Multidisciplinary Perspective, accessed January 15, 2025, https://ascopubs.org/doi/pdf/10.1200/EDBK_320301
42. FDA Approves First Cellular Therapy to Treat Patients with Unresectable or Metastatic Melanoma, accessed January 15, 2025, https://www.fda.gov/news-events/press-announcements/fda-approves-first-cellular-therapy-treat-patients-unresectable-or-metastatic-melanoma
43. Advances in Melanoma and Other Skin Cancers Research – NCI, accessed January 15, 2025, https://www.cancer.gov/types/skin/research
44. Treatment of Advanced Melanoma in 2020 and Beyond – PMC, accessed January 15, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7541692/
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