Palliative Care for Melanoma Patients

Palliative care does not offer a cure for melanoma. Instead, treatments reduce symptoms and reduce the rate of disease progression. Palliative care is most often used for advanced or metastatic skin cancer, although treatment to reduce symptoms may be used at any stage of the disease.

Once melanoma metastasizes, surgery can no longer cure the skin cancer. However, surgical removal of the original tumor may help slow the disease and relieve advanced symptoms such as bleeding, pain and ulceration of the tumor.

Although radiation therapy is rarely used to treat melanoma directly, it is often used in palliative care. When melanoma metastasizes to other parts of the body, radiation therapy may be used to reduce symptoms and as pain management. Melanoma tends to metastasize to the lymph nodes, the brain and the bones, although the cancer may spread to any location in the body.

External radiation therapy delivers a highly focused beam of radiation through the skin to tumors, killing cancer cells. A newer method, internal radiation therapy, works by implanting small radioactive materials called radioisotopes as close to the tumor as possible. The proximity of the radioisotopes to the cancer cells allows higher doses of radiation to be delivered for longer periods of time, while reducing the exposure of healthy tissue to the radiation.

Chemotherapy uses powerful drugs to kill fast-growing cells. The drugs are systemic, meaning that they affect the entire body, not just the cancer cells. As a result, any fast-growing cells are damaged during chemotherapy, leading to side effects such as hair loss, fatigue and nausea.

If the melanoma is confined to one limb, an experimental procedure called hyperthermic isolated limb perfusion may be possible. A tourniquet is applied to the limb to temporarily halt blood flow. Chemotherapy medication is then delivered to the limb. In theory, this allows the chemotherapy to have the maximum effect on cancer cells, while minimizing the rest of the body's exposure to the medication. Isolated limb perfusion is under clinical investigation, and is only available through clinical trials at this time.

Dacarbazine is a medication that can slow or stop the growth of cancer cells, making the drug a possible treatment for melanoma that has metastasized. Clinical trials are investigating the effectiveness of dacarbazine when combined with other medications.

An antibody called MDX-010 is currently being studied for its effects as a treatment for melanoma that has metastasized when combined with dacarbazine. MDX-010 targets a molecule called CTLA-4 that is found on T cells. CTLA-4 suppresses the immune system. MDX-010 targets and blocks CTLA-4, boosting the immune system, and strengthening the body's natural defenses.

Resources

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American Melanoma Foundation. (nd). Surgery. Retrieved May 20, 2003, from
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Medlineplus.gov. (updated 2003). Dacarbazine. Retrieved May 21, 2003, from
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Medarex. (2002). Medarex initiates phase II clinical trials of
MDX-010 for metastic melanoma and prostate cancer. Retrieved May 21, 2003, from
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National Cancer Institute. (updated 2002). Melanoma (PDQ) treatment. Retrieved May 20, 2003, from
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National Cancer Institute. (2003). What you need to know about melanoma. Retrieved May 20, 2003, from
www.cancer.gov/cancerinfo/wyntk/melanoma#13.

Oncology Channel. (updated 2003). Melanoma. Retrieved May 20, 2003, from
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