Surgery The removal of the tumor , along with sufficient margins of normal skin, is the only curative
treatment for all but the most advanced stages of disease. Nearby lymph nodes may also be removed if they are involved. Surgical removal of a single brain metastasis is also very useful to control the tumor in a later stage.
Chemotherapy Single-drug chemotherapy is effective in no more than 20 percent of patients with
advanced disease. Recent reports suggest that drug combinations can cause responses—more than 50 percent shrinkage of all tumor masses for at least four weeks—in 40 to 64 percent of cases. The percentage of complete remissions is low and the duration of response is still fairly short, but the increased percentage of responses is encouraging.
High-dose chemotherapy with drugs such as Thiotepa or melphalan , followed by replacement of the patient's own stored bone marrow—autologous bone marrow transplantation—has similar high response rates, but the short duration of remission (four months) does not yet justify the considerable risk of mortality (15 to 25 percent). ( See also Hyperthermic Perfusion Therapy .)
Radiation Radiation therapy can help shrink isolated large lesions, particularly nodules under the
skin, or relieve pain, but high individual doses of at least 500 cGy are usually required to overcome the resistance of melanoma cells to radiation. Somewhat lower radiation doses (300 to 400 cGy) are used for brain
