Electrochemotherapy for advanced melanoma skin cancer

Electrochemotherapy is a treatment that combines chemotherapy with small electrical pulses.

It is used to treat advanced melanoma skin cancer. The aim of electrochemotherapy is to help control the cancer and any symptoms you have.

What is electrochemotherapy?

Chemotherapy uses anti cancer drugs to destroy cancer cells. Sometimes doctors use the word cytotoxic to describe the way chemotherapy works. Cytotoxic means toxic to cells.

The electrical pulses make it easier for the chemotherapy to get into the melanoma cells.

Your doctor injects chemotherapy into the melanoma or into your bloodstream. They then put a probe into or near the melanoma. The probe gives out electrical pulses. This changes the outside of the melanoma cells and helps the chemotherapy get into them.

When you might have electrochemotherapy

You might have electrochemotherapy for melanoma that has spread to other areas of skin (skin metastases) and either:

• you can’t have surgery to remove them
• other treatments are not working

This may be a stage 3 or 4 melanoma.

How you have electrochemotherapy

An anaesthetist may give you a general anaesthetic so you are asleep during the procedure. Or you might have a local anaesthetic injection to numb the area and a drug to make you sleepy (sedation). 

Having the chemotherapy

Your doctor injects the chemotherapy into your bloodstream through a small tube (cannula). This is called intravenous chemotherapy. Occasionally they might inject the chemotherapy straight into the melanoma. This is called intratumoural chemotherapy.

They normally use a chemotherapy drug called bleomycin. Sometimes they use a different chemotherapy called cisplatin.

How long after the chemotherapy you have the electrical pulses depends on whether your doctor injects it:

• into your bloodstream
• straight into the melanoma

Your doctor gives you the electrical pulses 8 minutes after you’ve had the chemotherapy into your bloodstream. This gives the chemotherapy time to get to the melanoma.

If they inject the chemotherapy straight into the melanoma, they give you the electrical pulses immediately after. This is because the chemotherapy is already in the melanoma

Having the electrical pulses

Once the chemotherapy is at the melanoma, your doctor uses a probe that is attached to a special machine. The probe is the size of a large pen and has electrodes on the end. They put the electrodes into the melanoma or the skin around it. The electrodes send out electrical pulses into the cells.

How long it takes to have the treatment depends on the number and size of the skin metastases. You may need more than one treatment if the metastasis is large.

After electrochemotherapy

After the treatment it is normal for the area around the melanoma to be:

• swollen
• bruised
• painful

You can normally go home the same day as the treatment. But some people may need to stay in hospital overnight.

How you look after the area depends on whether you had a dressing on the melanoma before the treatment or not.

If you didn’t have a dressing

You don’t normally need one afterwards. This means you can wash the area normally. Using a sensitive or unperfumed soap or shower gel is best. This is because normal or perfumed soaps and shower gels may irritate the skin. Body lotion can also cause irritation. Gently pat the area dry with a towel after washing.

If you had a dressing

You can usually continue using the same type of dressings after the procedure. Follow the same instructions for looking after the area as before. Your nurse or doctor will tell you if you need to do anything different. If you have a district nurse, they will continue to look after the wound.

Side effects of electrochemotherapy

Your doctor gives you a lower dose of chemotherapy if you are having electrochemotherapy than if you are having the chemotherapy on its own. This is because the electrical pulses help the chemotherapy get into the melanoma cells. It means you are less likely to have side effects.

The chemotherapy might make you feel sick afterwards. But this is usually mild and you can have anti sickness medicines to help.

Other side effects are usually from the electrical pulses and not the chemotherapy drugs. These include:

Pain

The main side effect is pain in the area where the electrodes touch the skin. This is usually mild and lasts for a couple of days. Rarely people have more severe pain that can last between 2 and 4 weeks. Your doctor or specialist nurse will give you some painkillers if you need them. 

Muscle contractions

Some people have muscle contractions during the treatment. Your doctor can alter the way they give the treatment if these are uncomfortable.

Infection

Infection in the treatment area is rare. You might get a slight temperature after the treatment. But your doctor will give you antibiotics to reduce the chance of an infection. Tell them if there is any leakage of fluid (discharge) from the area. Or it becomes:

• red
• swollen
• painful

Changes to skin colour

You might notice the colour of your skin changes where you had treatment. It might be darker or lighter. This usually goes with time but can be permanent for some people.

Skin breakdown

The area where you have treatment can form an ulcer or the skin might breakdown. If this happens you might need regular dressing changes until it heals. This might take a couple of weeks. Your hospital or GP practice will arrange this.

Where can you have electrochemotherapy treatment?

Electrochemotherapy is only available in some hospitals in the UK. This means you may not be able to have treatment at your local hospital. So you may need to travel to another hospital to have it.

Talk to your doctor if you are interested in having electrochemotherapy. They can tell you if it is suitable for you and if it’s available in your area.