Melanoma Treatment: Stage III

Stage III Melanoma

This stage of melanoma is when there is a spread into the nearby skin or more commonly, the lymph nodes or glands. Initially, a biopsy is performed and the pathology will show the Breslow Level or depth of the melanoma and then if it measures from .76-1.00, a Sentinel Node Biopsy will be recommended. See more on Pathology and Sentinel Node Biopsy under the tab Melanoma Info.

The difficulty lies in figuring out if the melanoma cells are still active in the body perhaps traveling to create a tumor in other organs or tissue. Ideally, you want something like a pre-emergent weed killer, which is called adjuvant therapy, that eliminates these cells before they can colonize into a tumor. As of this writing, there are very slim options for adjuvant therapy. Alpha interferon is one that is approved by the FDA, but less likely to be prescribed currently. Scientifically based evidence shows no overall survival advantage to this therapy and the toxicity can make it intolerable.

Other changes are occurring in stage III. Complete Node Dissection was recently found to not extend overall survival, especially in the detection of micro-mets are found in the nodes. The study presented at ASCO will most likely be replicated in the U.S. since there still remains some consensus to do the radical node dissection.

Exciting advances are being made with the new stage IV therapies that may carry over to the stage III setting. Yervoy (IPI), Opdivo, and Keytruda (the Pd1s), and the Braf therapies are all being studied in clinical trial to see if they are suitable as an adjuvant therapy for stage III. Yervoy was approved by the FDA, October 28th, 2015, from data based on a the study: EORTC 189071 published HERE.

In addition, there are two adjuvant therapies for melanoma that are designed to treat in-transit lesions that have spread to the surface below the skin. These are called intralesional therapies, and the idea behind them is to inject an agent that destroys the melanoma lesion and also create a bystander effect to other melanoma cells. The two currently tested therapies are called T-vec and Pv-10. Combining these agents with the immunotherapies looks even more promising.

Patients now have an adjuvant therapy choice for the first time in 20 years.

Source: Melanoma: Not Just Skin Cancer, by Catherine M. Poole; Contributing editors: Keith Flaherty, MD, DuPont Guerry, MD and Jedd Wolchok, MD, 2015.

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UPDATED: February 7, 2018