Diagnosis & Treatment
Melanoma Diagnosis and Treatment Information
A new diagnosis is a stressful time; shock, anger, and frustration are natural reactions. This often makes it difficult to think straight and understand or assess all of the new information that you are receiving.
It is important to be an active participant in your treatment; you need to understand you diagnosis and any potention treatment options for your stage of cancer, not just the standard treatment. Before you undergo any treatment do your homework. It can be helpful to discuss your stage and treatment plans with other patients who have had similar experiences.
DIAGNOSIS & STAGING
Skin Biopsy
If your doctor or dermatologist finds a suspicious mole, a biopsy, or removal of tissue for examination under a microscope, is taken and examined.
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Diagnosing Melanoma: Pathology Report
Once the biopsy has been completed, the tissue sample will be sent to a lab for review. A pathologist then evaluates the cells tissues to help diagnose the disease if present.
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Surgical Tests Prior to Final Staging: Melanoma Biopsy
Once the biopsy is completed, patients with early stage ‘in-situ’ melanoma will likely not require any further surgery. Others, with thicker melanomas, may undergo a second wide local excision (WLE) to remove additional tissue.
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Melanoma Diagnostic Tests
Once the presence of melanoma is confirmed, your doctor may wish to perform other melanoma diagnostic tests, especially if you have symptoms or if there is concern that the melanoma may have spread. These could include blood tests or imaging tests such as X-rays or MRIs.
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Staging Melanoma
Once all tests have been completed and pathology reports have been received, doctors will try to figure out if the cancer has spread, and if so, how far. They’ll do a “TMN” test that checks the thickness of the tumour, lymph node involvement and metastasis.
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Staging 0-IV
Melanoma has five stages: 0, I, II, III, IV. Early melanoma is defined as stage I and stage II disease, while Advanced melanoma is defined as stage III and stage IV disease.
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TREATMENT
Treating Melanoma
The main factors affecting treatment options are: depth, presence of ulceration and lymph node involvement. Deeper melanomas are more likely to have spread. They are also more likely to recur, or come back after treatment.
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Surgery
Melanoma surgery removes the cancer and a border of normal tissue around it. The scope of any required surgery depends on the size and stage of the melanoma and the amount of normal tissue removed at biopsy.
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Immunotherapy
Immunotherapies are a new class of drugs that have been developed to stimulate a person’s own immune system to recognize and destroy cancer cells.
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Targeted Therapies
Targeted therapy is a drug therapy that targets melanoma cells. It’s goal is the shut down mutated protein molecules and slow the growth of melanoma cells - without harming healthy tissue.
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Adjuvant Therapies
Adjuvant therapy is additional cancer treatment used after surgery to reduce the risk of the cancer returning.
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Radiation Therapy
Radiation therapy uses a high-energy beam to kill cancer cells, that is usually used after surgery to kill any remaining cancer cells. Radiation may be used to achieve local control of a melanoma if surgery is not possible, or to treat recurring melanoma.
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Chemotherapy
Chemotherapy uses powerful drugs to kill cancer cells. These drugs may be given as pills or by injection or infusion into a vein. If the cancer is concentrated in one limb, it may be administered directly to the affected area in a technique known as isolated limb perfusion.
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MELANOMA DRUG THERAPIES IN CANADA
Braftovi (Encorafenib) + Mektovi (Binimetinib)
Braftovi is an oral small molecule BRAF kinase inhibitor and mektovi is an oral small molecule MEK inhibitor, which target key enzymes in the MAPK signaling pathway (RAS-RAF-MEK-ERK).
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Cobimetinib (Cotellic) + Vemurafenib (Zelboraf)
COTELLIC is a prescription medicine that is used with the medicine ZELBORAF, to treat melanoma:
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Dabrafenib (Tafinlar) + Trametinib (Mekinist)
Dabrafenib (Tafinlar) capsules and trametinib (Mekinist) tablets are prescription medicines that can be used in combination to treat melanoma
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Ipilimumab (Yervoy)
Ipilimumab is given intravenously and can lengthen life in people with advanced disease with melanoma that can’t be removed by surgery or that has spread to other parts of the body.
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Nivolumab (Opdivo)
This is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells) that normally help keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells.
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Nivolumab (Opdivo) + Ipilimumab (Yervoy)
Nivolumab (Opdivo) + ipilimumab (Yervoy) are immune checkpoint inhibitors that target separate, distinct and complementary checkpoint pathways (PD-1 and CTLA-4),1 which increases your body’s immune response.
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Nivolumab (Opdivo) + Relatlimab (Opdualag)
Opdualag is a premixed combination of nivolumab and relatlimab that is prepared and given through intravenous (IV) infusions. Opdualag is a prescription medicine used to treat adults with advanced melanoma that has spread or cannot be removed by surgery.
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Pembrolizumab (Keytruda)
This drug is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells), that normally help keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells.
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Trametinib (Mekinist)
MEK inhibitors block the activity of a cell protein called MEK, a molecule that helps regulate cell growth.
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Vemurafenib (Zelboraf)
Vemurafenib (Zelboraf) is a first-line treatment for patients with BRAF V600 mutation-positive unresectable stage IIIC or IV melanoma or metastatic melanoma.
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Find a Clinical Trial
Melanoma Canada’s clinical trial finder connects patients and physicians exploring treatment options with clinical trials, using transformational clinical trial matching technology.
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HEALTH AND NUTRITION
Dealing with a Diagnosis
Being diagnosed with cancer can feel overwhelming. Managing cancer involves much more than effective treatment. Adjusting to and finding ways to cope with a melanoma diagnosis is an important part of healing, along with treatment.
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Managing Melanoma
Whatever the stage of your cancer, it is important that you look after your physical health. That means eating a healthy diet, getting enough rest, and being as physically active as you can be. It is also important to care for your emotional health by spending time with family and friends and planning activities you enjoy.
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Managing Advanced Melanoma
Receiving a cancer diagnosis, especially in the later stages, can dredge up a variety of emotions such as feelings of anxiety, fear and hopelessness. It’s important to note that even when you feel out of control, there are always ways to take charge, and this starts by learning more about your diagnosis.
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Managing Cancer Fatigue
Cancer-related fatigue is the most common and often the most distressing side effect experienced by people with cancer.
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How to stay well nourished and hydrated?
Getting all of the nutrients your body needs can help you maintain your weight and strength, stay active and support your recovery – all important factors in managing cancer-related fatigue.
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Vitamin D
We need vitamin D to absorb calcium, to build and maintain bones and teeth, and to support our immune system, but most of us won’t get enough of this important vitamin without using a supplement.
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How to Manage Diarhea During Cancer Treatment?
When you are experiencing diarrhea, eating well can be a challenge. Diarrhea caused by cancer treatment is best managed with prescription medications.
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How to be Active with Cancer?
If you haven’t been exercising, start slowly and build up the time and intensity of your physical activity.
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OTHER INFORMATION
Melanoma Recurrence
Fear of recurrence is a universal concern of individuals with a cancer diagnosis and is one of the most frequent concerns for those who have completed treatment..
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Lymphedema
Lymphedema is the build-up of lymph fluid in the body’s tissues due to damage in the lymphatic system.
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Fertility & Family Planning
As survival rates rise among young cancer patients, so does the importance of discussing fertility preservation and family planning with healthcare providers.
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Questions to ask your doctor
It is often difficult to think of the right questions while you are in an appointment. We have a list of questions to ask your doctor at each stage of your melanoma or skin cancer journey.
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Flushot & Covid Vaccine Information
It is important to speak to your healthcare team to discuss further medical advice receiving this vaccine.
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Feature Video
Helping You Understand Melanoma: A Patient Guide
Skin Cancer Resources
Melanoma & Skin Cancer Clinical Trials
Clinical trials provide individuals with cancer access to the newest types of treatment. These trials are studies of new therapies to determine whether a medication is safe and effective.
Find a Clinical TrialFind a Treatment Centre Near You
A list of melanoma and skin cancer specialist at treatment centres across Canada. Type in your postal code in the search tool below to find a centre near you.