Melanoma Infusion

Cancer Chemotherapy There are new options for treating melanoma.

by Jennifer Abney

Published: Thu, September 04, 2008 - 4:28 am CST Last Updated: Thu, September 04, 2008 - 11:21 pm CST

Melanoma is a type of skin cancer that forms in the melanocytes, the cells that give skin its color. It is the least common form of skin cancer, but the most deadly. This year, the American Cancer Society estimates 62,480 new cases of melanoma will be diagnosed in the U.S. About 8,420 people will die from it.

The most important risk factor for melanoma is excessive exposure to the sun. According to the Skin Cancer Foundation, having just one blistering sunburn during childhood doubles the risk for melanoma later in life. Some other risk factors include: having a large number of moles (especially atypical moles, called dysplastic nevi), fair skin, family history of melanoma, personal history of melanoma and weakened immune system.

When possible, doctors will try to surgically remove the melanoma tumor and a small margin of surrounding healthy tissue. Melanomas can quickly invade underlying tissue, so even a tiny spot on the skin’s surface can require a deep incision and, sometimes, a skin graft. Chemotherapy may be given to attack any cancer cells that have been missed or strayed from the site.

Melanoma In-transit
About 10 percent of patients with advanced or recurring melanoma develop a condition called melanoma in-transit. It’s characterized by the formation of multiple tumors in a limb. The tumors follow the path of the lymph channel from the original tumor site towards the nearest lymph nodes.

Researchers say once the patient develops multiple metastatic tumors in a limb, quality of life is generally very poor. The tumors can grow quite large and may ulcerate, bleed and become painful and infected. Limb function is greatly reduced due to the size and number of lesions. Median survival is 19 months. Only 12 percent of patients live for five or more years.

Treatment Options for Melanoma In-Transit
Standard chemotherapy is often ineffective to control melanoma in-transit. Some patients may gain relief with a BCG vaccine injected into the tumors. BCG is a bacterium related to tuberculosis. It doesn’t kill the cancer cells, but it can stimulate the body’s immune system and enhance the ability to naturally fight the cancer and ease symptoms.

A newer treatment option is isolated limb infusion. Small catheters are inserted into an artery and a vein in the groin and fed into the affected limb, just above the area of the tumors. Next a tourniquet is placed on the limb above the catheters. Then, high doses of the chemotherapy drug, melphalan, are infused through the isolated section of the limb. A small pump keeps the anticancer drugs flowing through the arteries and back out the veins. The tourniquet prevents the medication from going to the rest of the body. The treatment is given for 30 minutes. Then, the medication is washed out of the limb with saline solution and the tourniquet and catheters are removed.

Vadim Gushchin, M.D., a Surgical Oncologist at Mercy Medical Center in Baltimore, says isolated limb infusion exposes the cancer to high doses of chemotherapy while protecting healthy tissue outside the limb from the side effects of the drug. He says, in the past, doctors used large catheters and a large surgical incision in the groin. The newer treatment uses much smaller catheters that can be inserted through a tiny wound puncture.

Gushchin says isolated limb infusion is only useful for patients whose disease is confined to a limb. He cautions the treatment is not a cure for advanced or recurring melanoma. Up to 60 percent of patients experience a recurrence. If the recurrence occurs in the limb, isolated limb infusion can be repeated. But in many cases, the cancer recurs in another area of the body.

There are some potential side effects of isolated limb infusion. Patients may experience swelling and inflammation in the limb, sloughing of the skin and muscle damage. However, the treatment can improve quality of life for some time.

For information about Isolated Limb Infusion at Mercy:
http://www.mdmercy.com/hospitalservices/mediarelations/articles/010308_ili.html

For general information about melanoma:
American Cancer Society, http://www.cancer.org
National Cancer Institute, http://www.cancer.gov
Skin Cancer Foundation, http://www.skincancer.org

WKRG.com » News Stream » Medical