Melanoma Treatment: Stages I to III
The beauty of melanoma is it is usually quite recognizable on the outside of the skin and can be found early. Stages I and II of melanoma are usually cured with simple outpatient surgery. But stage 3, where spread to lymph nodes becomes a concern, has few further treatment options. A viable treatment plan is to "watch and wait." This is to have regular check ups and be vigilant about your body. There may be a few clinical trials as well. There is one FDA approved drug for stage III disease called Intron-A or interferon. Many people opt for this drug although the FDA no longer holds it as the gold standard and many top melanoma specialists stopped prescribing it. However, there are other agents in the wings that may gain approval in 2011. Be sure to look for clinical trials for stage III at www.clinicaltrials.gov. Alpha-interferon is a biotechnically synthesized protein that is identical to a protein the body produces when it fights off viral infections. Alpha-interferon is the only agent currently approved by the Federal Drug Administration as adjuvant therapy for melanoma patients. The approval was based on a clinical research study, published in the January 1996 Journal of Clinical Oncology, in which patients with thick melanomas or regional lymph node involvement received either high doses of alpha-interferon or no adjuvant therapy. Five years later, 46 percent of the patients treated with inter-feron were still alive, as opposed to only 37 percent of the untreated patients.
When given in the high doses that are apparently necessary to treat melanoma effectively, alpha-interferon has many side effects. Patients taking it feel at first as though they have the flu. This effect wears off with time and can be alleviated with other medicines. Alpha-interferon may cause severe toxic damage to the liver, significant decreases in blood count, hair loss, and neuropsychological reactions. A thorough psychological profile should be considered before prescribing intron-A, as it can have dire affects on those with a history of mental illness or depression.
A one-year course of alpha-interferon (the recommended duration) costs between $15,000 and $30,000 for the medicine alone. Other medical costs can add to this. The first twenty doses are given intravenously in a doctor's office five days out of seven for a month. Blood tests need to be done frequently. Medical insurance should pay for alpha-interferon as well as the other expenses incurred.You will need to discuss with your doctor, probably a medical or surgical oncologist, whether alpha-interferon is for you.
If you are twenty-eight years old and have a 10 percent chance of a cure you may be willing to put up with the side-effects and the expense of this treatment. If you are seventy-four and have a 70 percent chance of survival, you probably aren't going to want to endure a year of feeling miserable. This is a very individual decision, best made by you and your doctor. Keep in mind that the older and more infirm you are, the less favorable your risk-to-benefit ratio. The 2010 proceedings of the American Society of Clinical Oncology stated that interferon has not been shown to extend overall survival of melanoma patients.
SOURCE: Poole, Catherine, Guerry, DuPont, M.D., Melanoma Prevention Detection and Treatment, New Haven: Yale University Press, 2005.
UPDATE: March 6, 2011
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