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What is the first-line treatment for melanoma?

Dr. Ellen Marmur, MD
Dermatology

The first-line treatment (the best plan of attack) for most skin cancers, especially melanoma, is surgery. Sometimes surgeons can do only a partial excision if the tumor is too large or affects an essential body part such as the spine, heart, or brain. Surgery for melanoma is much more invasive and extensive than excision of other skin cancers because the cancer grows vertically - deep down into the skin. Melanoma is like mold inside your walls; it seeps down deeply and can destroy anything in its path. For this reason, surgeons sometimes have to go past the fat layer of skin to the muscle in order to take out a tumor. It's also necessary to take wide margins to make sure the cancer hasn't leeched into healthy tissue nearby. Usually surgery for melanoma is an outpatient procedure, unless the area of skin to be excised is very large.

When a surgeon excises melanoma that is deeper than one millimeter, he or she always discusses the option to check to see if the lymph nodes are involved by doing a sentinel lymph node biopsy. If melanoma is detected there, the doctor usually surgically removes the cancerous nodes, then may also irradiate the area or propose adjuvant therapy. (This is considered Stage III melanoma.) Cancers can spread in the tissue, through the bloodstream, or in the lymph nodes (which are part of the circulatory system). Lymph vessels are spider web - delicate and course throughout the body. They act as a super-highway for immune cells. The lymph nodes, located in various areas - such as the underarms, groin, elbow area, and lungs - are like rest stops. At the core of each node is the germinal center, where immune cells are made, become specialized, and are released into the body to provide disaster relief where it's needed. When cancer invades the lymph nodes, it can obviously spread even faster on this super-highway. At this advanced stage, even with successful treatment, there is a 30 to 50 percent chance the cancer will recur.

Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

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Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

What if a leading dermatologist just happened to be your best friend and you could ask her anything? DR. ELLEN MARMUR, a world-renowned New York City dermatologist, answers all your questions with...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.