Treatment Options for Stage II Melanoma
After your stage of melanoma has been identified, your doctor will discuss a plan of treatment with you. Treatment of Stage II melanoma can include surgery, sentinel lymph node biopsy, immunotherapy, and clinical trials.
The purpose of surgery is to remove any cancer remaining after the biopsy. The procedure is called wide local excision. Surgery is the main treatment for Stage II melanoma. The surgeon removes the rest of the tumor, including the biopsy site, as well as a surgical margin, (a surrounding area of normal-appearing skin), and underlying subcutaneous tissue to make sure the whole tumor has been removed. The width of the margin taken depends upon the thickness of the primary tumor. Most surgeons follow the guidelines adopted and recommended by the National Institutes of Health and the World Health Organization Melanoma Program:
- Stage IIA & IIB – 2 cm margin – about .75 inch – for tumors between 1.1 mm and 3.99 mm in depth (Breslow Depth)
- Stage IIC – 2-4 cm margin – about .75 inch to 1.5 inch – for tumors greater than 4 mm; 2 cm margin – about .75 inch – for tumors between 1.1 mm and 3.99 mm in depth (Breslow depth)
Recent advances in surgery allow surgeons to take narrower margins than before, so a much greater amount of normal skin is preserved.Learn more about surgery
Sentinel Lymph Node Biopsy (SLNB)
Sentinel lymph node biopsy is recommended for all Stage II tumors regardless of size. Sentinel node biopsy is most accurate when it is performed before wide local excision, the surgery to remove the tumor and the surrounding skin.
- Determine whether any cancer cells have spread to the sentinel node, the first lymph node to receive drainage from the primary tumor, and the site where melanomas commonly spread to first.
- Further treatment will depend on whether the lymph node biopsy is positive.
Systemic treatment, given after surgery to remove all the melanoma may be recommended for patients with Stage IIB or IIC melanoma. These systemic therapies go in the bloodstream in an effort to reach and destroy any remaining cancer cells throughout the body.
- Interferon is a protein produced by normal cells to fight viral infections and disease and is used in large doses to treat melanoma as an immunotherapy.
- Interferon therapies have been shown to help the body’s immune system fight certain diseases more effectively.
- Several studies indicate that high dose interferon alfa-2b, a manufactured form of interferon, consistently delays relapse/recurrence of melanoma in patients with Stage IIB/C. However, studies have not consistently shown that interferon can extend overall survival.
Clinical trials are research studies to evaluate new therapies and improve cancer care. These studies are responsible for most of the advances in cancer prevention, diagnosis, and treatment. If you have melanoma, you may be eligible to participate in a clinical trial. Several treatments for Stage IV melanoma are currently being tested in clinical trials for Stage II:
- Yervoy (ipilimumab), Keytruda (pembrolizumab), Opdivo (nivolumab), and other therapies designed to boost the immune system to fight the return of melanoma
- Targeted therapies and targeted therapy combinations that work by blocking the function of the mutated BRAF protein
- Vaccines that may improve the specific immune response to melanoma