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The treatment of melanoma is dependent on the stage of the disease at the time of diagnosis. Staging is a technique often used to categorize various kinds of cancer according to the extent of the cancer in the hope that this will help the doctor to predict the behavior of the disease and select the best treatment. Stage 1 melanomas (thin lesions) that have not metastasized have an excellent prognosis and generally only require an excision of the tumor with an appropriate margin of normal tissue. Thicker tumors or tumors that appear to have spread to other parts of the body have a much poorer prognosis. For melanomas of intermediate thickness with no evidence of metastatic spread, a new technique called sentinel lymph node biopsy has been developed which is useful in predicting the progression of the disease. This is performed by injecting a radioactive tracer and/or a dye at the site of the tumor and tracing it to the local lymph nodes that drain the site of the cancer. Once identified, these lymph nodes are removed and examined by the pathologist to determine if they have been invaded by the melanoma. Lack of invasion is a good sign.
Once a melanoma has metastasized to draining regional lymph nodes or to a more distant site, treatment options become more complicated and good outcomes much less common. Such treatments include regional lymph node dissection, interferon injections, radiation therapy, immunotherapy, regional limb profusion (chemotherapy limited to an extremity), and systemic chemotherapy.
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