Options for treatment of stage III melanoma are as follows:

• Surgery is recommended for small, easily removable, recurrent tumors and for patients with a limited number of in-transit tumors. The goal of surgery is to remove any remaining cancer after the biopsy. The procedure is called wide local excision. The surgeon removes the tumor including the biopsy site, as well as a surgical margin, a surrounding area of normal-appearing skin and underlying subcutaneous tissue. The width of the margin taken depends upon the thickness of the primary tumor. Recent advances in surgery allow surgeons to take narrower margins than before, so a much greater amount of normal skin is preserved. (See Surgery for more information.)
• Therapeutic lymph node dissection (TLND) is surgery to remove all regional lymph nodes from the area where cancerous lymph nodes were found. It is highly recommended for patients with macrometastases. The goal of the surgery is to prevent further spread of the disease through the lymphatic system. TLND also plays an important role in controlling the pain often caused by untreated lymph node disease.
• Lymphatic mapping and sentinel node biopsy are generally not recommended for patients with clinically diagnosed Stage III disease. However, they may be recommended for patients with certain subgroups of Stage III disease. The purpose is to determine whether any cancer cells have spread to the sentinel node, the first lymph node to receive drainage from the primary tumor. The results of the biopsy will guide the course of treatment. Sentinel node biopsy is most accurate when it is performed before surgery to remove the tumor and surrounding skin. (See Lymph Node Evaluation for more information.)
• Adjuvant therapy is a treatment given in addition to a primary cancer treatment such as surgery. Systemic therapies use substances that travel through the bloodstream to reach and affect cancer cells throughout the body. Established treatments include interferons, natural substances produced by the normal cells of most body tissues in response to viral infections and disease. Manufactured forms of interferons have been shown to help the body's immune system fight disease more effectively. Studies indicate that interferon alfa-2b, a manufactured form of interferon, is the only adjuvant treatment to significantly prolong disease-free and overall survival in patients with Stage III melanoma.
• A variety of experimental vaccines are under evaluation. Like interferons, they may help boost the immune system to fight the return of melanoma. Clinical trials for Stage II melanoma are investigating how vaccines work to produce immune responses. Vaccines have not yet been shown to extend overall survival in any randomized, controlled trials for any stage of melanoma. Vaccine therapy is also being investigated as a therapy for patients who cannot tolerate the side effects of immunotherapies, such as interferon. (See Biological Therapy for more information on immunotherapy and vaccine therapy.)
• Adjuvant radiation therapy has not been proven to be of benefit in randomized, controlled studies but is sometimes recommended when the tumor has grown outside the lymph nodes into the surrounding tissue (extracapsular spread). The goal is to control the further spread of the disease. (See Radiation Therapy for more information.)

See also Follow-Up Management: Stage III.

About Clinical Trials

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.

See Clinical Trials to learn more about these studies, or go directly to the Stage III Clinical Trials list.