Chemotherapy for Melanoma Skin Cancer
Chemotherapy (chemo) uses drugs that kill cancer cells. The drugs are usually injected into a vein or taken by mouth as a pill. They travel through the bloodstream to all parts of the body and attack cancer cells that have already spread beyond the skin.
When might chemo be used?
Chemo can be used to treat advanced melanoma, but it’s not often used as the first treatment since newer forms of immunotherapy and targeted drugs have become available. Chemo is usually not as effective for melanoma as it is for some other types of cancer, but it may relieve symptoms or extend survival for some patients.
Which chemo drugs are used to treat melanoma?
Several chemo drugs can be used to treat melanoma:
- Dacarbazine (also called DTIC)
Some of these drugs are given alone, while others are often combined with other drugs. It’s not clear if using combinations of drugs is more helpful than using a single drug, but it can add to the side effects.
Some studies suggest that combining chemo drugs with immunotherapy drugs such as interferon-alpha and/or interleukin-2 (see Immunotherapy for Melanoma Skin Cancer) might work better than a single chemo drug alone, although it’s not clear if this helps people live longer. This type of treatment is also called biochemotherapy or chemoimmunotherapy.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks.
Isolated limb perfusion: This is a way of giving chemotherapy that is sometimes used to treat advanced melanoma that is confined to an arm or leg. It is done during a surgical procedure. The blood flow of the arm or leg is separated from the rest of the body, and a high dose of chemotherapy is circulated through the limb for a short period of time. This lets doctors give high doses to the area of the tumor without exposing other parts of the body to these doses, which would otherwise cause severe side effects.
To do this, a tube is placed into the artery that feeds blood into the limb, and a second tube is placed into the vein that drains blood from it. The tubes are connected to a special machine in the operating room. A tourniquet is tied around the limb to make sure the chemo doesn’t enter the rest of the body. Chemotherapy (usually with a drug called melphalan) is then infused into the blood in the limb through the artery. During the treatment session, the blood exits the limb through the tube in the vein, is heated by the machine (to help the chemo work better), and is then returned back to the limb through the tube in the artery. By the end of the treatment the drug is completely washed out of the limb, and the tubes are removed so that the circulation is returned to normal.
Possible side effects of chemotherapy
Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are used. The side effects of chemo can include::
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea or constipation
- Increased risk of infection (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
These side effects usually go away once treatment is finished. There are often ways to lessen side effects. For example, drugs can help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about drugs to help reduce side effects.
Some chemo drugs can have other side effects. For example, some drugs can damage nerves, which can lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This condition is called peripheral neuropathy. It usually goes away once treatment is stopped, but for some people it can last a long time.
Be sure to talk with your cancer care team about what to expect in terms of side effects. While you are getting chemo, report any side effects to your medical team so that they can be treated promptly. In some cases, the doses of chemo may need to be reduced or treatment may need to be delayed or stopped to prevent side effects from getting worse.
To learn more, see the Chemotherapy section of our website.
Last Medical Review: May 19, 2016 Last Revised: May 20, 2016