What "Stage III" Means
Melanoma is ranked in stages 0 to IV, with IV being the most severe. Lower stages start out as lesions on the skin, and higher stages indicate migration of the disease into the blood, lymph nodes and, possibly, the organs. Stage III melanoma is melanoma that is present in only the sentinel (or regional) lymph nodes, or lymph nodes closest to the site of initial cancer on the skin. Lymph nodes act as blood filters and catch things like viruses and other abnormal cells in the blood. There are lymph nodes in the groin, head and neck, and axilla (armpits). Doctors base decisions about which nodes to biopsy on where melanoma is found on the body.
Sugery & Radiation
With stage III melanoma, it is important to surgically excise all of the cancerous tissue from the primary site on the skin, as well as to surgically remove all of the infected sentinel lymph nodes. Removal of the nodes is important to prevent the cancer from spreading to other lymph nodes and, even worse, vital organs. Radiation to the site of lymph node dissection often follows surgery, to kill any remaining cancerous cells in the area.
Interferons
Immunotherapies called interferon and interleukin-2 are used to stimulate the body's immune system. After removing the cancer and lymph nodes, treatment targets any remaining cancer cells in the blood, so they do not metastasize to vital organs. According to the National Cancer Institute, interferon increased progression-free survival time in most patients in three different clinical trials.
Chemotherapy
According to the Mayo Clinic, melanoma has been resistant to chemotherapy until recently, when new forms were developed. While most chemotherapy options for melanoma are "off label," meaning they are not FDA approved to treat melanoma, chemotherapy is a worthwhile option to consider if the melanoma is resistant to immunotherapy. There are also clinical trials that use immunotherapy and chemotherapy together, as well as trials that are testing chemotherapy on its own for this disease.
Other Options
The American Cancer Society warns that standard treatments for stage III melanoma are not necessarily curative and won't work for everyone. For this reason, it is important to remember that clinical trials provide an option outside of the standard of care. Clinical trials are part of the FDA approval process for medications in the United States, and while no definite results are promised, they can provide the most cutting edge technologies. Treatments being tested include vaccinations, chemotherapy and gene therapy. If other treatments have failed, this is a promising option. Talk to your oncologist about clinical trials for stage III melanoma available in your area, and visit clinicaltrials.gov, where all clinical trials in the United States are listed, along with contact information for doctors who are conducting the studies.
Prognostic and Treatment Factors
Age, physical health and activity of the patient are prognostic and treatment factors. Most of the treatments for stage III melanoma are very aggressive, and can take a toll on the body. Elderly patients and patients who are not physically healthy before their diagnosis are often limited in their treatment options. In such cases, it is important to investigate clinical trials and alternative methods of treatment. Other prognostic factors include the location of the disease and how much it has spread. While stage III specifies that the disease is in the sentinel lymph nodes, the number of lymph nodes that are infected makes a difference in prognosis. After surgery, a pathological diagnosis will be able to predict how much the cancer has spread within the lymph node region. Fewer cancer cells in the lymph nodes means that the cancer has not spread as much, and potentially there is less residual cancer in the blood. Treatment protocols generally do not vary based on this outcome, however, as all advanced stages of melanoma should be attacked as aggressively as possible.
Tags: lymph nodes, clinical trials, stage melanoma, cancer cells, cancer spread