Surgical Treatment of Stage II Melanoma
Treatment of stage I-II melanoma typically involves a single surgical procedure in which a local excision of the cancer is performed as well as a sentinel lymph node biopsy (SLNB). When melanoma spreads it typically first invades the local lymph nodes so their evaluation is essential for treatment planning. If the lymph nodes are involved with cancer, additional systemic adjuvant treatment may be necessary. Approximately 15% of patients undergoing SLNB have a positive SLN for stage II disease(pathologically stage III).5
Adjuvant Treatment of Stage I-II Melanoma
Despite undergoing sentinel lymph node evaluations that are negative, some patients with stage II melanoma are at increased risk for having small amounts of cancer that have not been detected. Patients with thick melanomas (> 4 mm) who have evidence of ulceration are considered at high risk for recurrence. The delivery of cancer treatment aimed at killing micrometastases following local treatment with surgery is referred to as “adjuvant” therapy.
Patients should discuss the role of adjuvant interferon and participation in clinical trials evaluating newer precision cancer medicines and immunotherapy which have improved the outcomes of patients with stage III melanoma and are currently being evaluated in stage II disease. Patients should ask their doctor about these advances and if they should undergo genomic testing of their cancer and /or participate in a clinical trial evaluating newer adjuvant therapy treatments.6,7,8,9
1 Wagner JD, Gordon MS, Chuang TY, et al.: Current therapy of cutaneous melanoma. Plast Reconstr Surg 105 (5): 1774-99; quiz 1800-1, 2000.
2 Cohn-Cedermark G, Rutqvist LE, Andersson R, et al.: Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm. Cancer 89 (7): 1495-501, 2000.
3 Balch CM, Soong SJ, Smith T, et al.: Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas. Ann Surg Oncol 8 (2): 101-8, 2001.
4 Heaton KM, Sussman JJ, Gershenwald JE, et al.: Surgical margins and prognostic factors in patients with thick (>4mm) primary melanoma. Ann Surg Oncol 5 (4): 322-8, 1998.
5 Wong SL, Balch CM, Hurley P, et al.: Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol 30 (23): 2912-8, 2012.
6 Kirkwood JM, Strawderman MH, Ernstoff MS, et al.: Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol 14 (1): 7-17, 1996.
7 Kirkwood JM, Ibrahim JG, Sondak VK, et al.: High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol 18 (12): 2444-58, 2000.
8 Eggermont AM, Suciu S, Santinami M, et al.: Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomized phase III trial. Lancet 372 (9633): 117-26, 2008.
9 Ribas A, Hodi FS, Kefford R, et al. Efficacy and safety of the anti-PD-1 monoclonal antibody MK-3475 in 411 patients (pts) with melanoma (MEL). J Clin Oncol 32:5s, 2014.