Stage III Melanoma
Stage III melanoma includes cancers of any thickness that have spread to the regional lymph nodes. The extent or amount of tumor in the lymph nodes is the most important prognostic factor for patients with stage III melanoma. The presence of micrometastases, defined as tumor detected by sentinel lymph node biopsy, is more favorable than the presence of macrometastases, which are defined as clinically detectable nodal metastases. Similarly, one lymph node that contains tumor is more favorable than having four or more involved lymph nodes.
The following is a general overview of treatment for stage III melanoma. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, targeted therapy or some combination of these treatment techniques. Multi-modality treatment, which utilizes two or more treatments, is increasingly recognized as an important approach for improving a patient’s chance of cure or prolonging survival.
As a result of recent drug discoveries some new treatment options for stage III melanoma have recently become available. Clinical trials utilizing new, innovative therapies may provide the most promising treatment. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to inform patients about their treatment options and to facilitate a mutual or shared decision-making process with their doctor.
Surgical Treatment of Stage III Disease
Standard surgical treatment for patients with stage III melanoma is removal of the primary cancer with up to 2-centimeter (over an inch) margins of the adjacent skin, depending on the thickness of the primary tumor, and removal of all of the regional lymph nodes. Outcomes of patients with stage III melanoma relate primarily to the extent of lymph node metastasis.
Lymphatic mapping and sentinel lymph node biopsy (SLNB) are used to assess the presence of melanoma cells in the regional lymph nodes in order to help determine which patients may require regional lymph node dissections (LNDs) and adjuvant therapy.
SLNB should be performed prior to wide excision of the primary melanoma to ensure accurate lymphatic mapping. If metastatic melanoma is detected, a complete lymph node dissection (CLND) can be performed in a second procedure. Patients can be considered for CLND if the sentinel node(s) is microscopically or macroscopically positive.
CLND dissection may be performed in the neck, armpit or groin, depending on the site of the primary tumor and presence of palpable lymph nodes. Chronic side effects of removing lymph nodes vary, depending on the extent of disease, body habits of the patient, and inclusion of postoperative radiation to the site, but may include numbness, and swelling of the associated extremity, which is called lymphedema. Patients should discuss the risk of lymphedema and potential benefit of CLND with their doctor as there is some controversy regarding the role of CLNC.1, 2, 3 ,4 ,5
Patients with local regional spread of melanoma (stage III disease) and thick primary tumors are considered appropriate candidates for adjuvant therapy following surgery because of the high rate of melanoma recurrence and subsequent death following treatment with surgery alone. The ability to detect micrometastatic local regional disease has improved over the past decade with the adoption of new techniques such as sentinel lymph node (SLN) biopsy. In addition, the pathologic assessment of sentinel lymph nodes have improved with the availability of immunohistochemical staining which allows detection of nodal metastases as small as 0.1 mm or even aggregates of a few cells.1, 2, 3 ,4 ,5