Melanoma: Treatment Options

Treatment for Melanoma

Most melanoma is treated with one or more of the following treatments:

Every treatment has potential risks and side effects. Before any new treatment or surgery, make sure your healthcare team tells you about what to expect. 

Surgery for melanoma

Surgery is usually the main treatment for melanoma.

• Wide excision surgery, removing additional tissue around the cancer is used for melanomas that are thicker. 
• Sentinel lymph node mapping is used during surgery to check if the cancer has spread to nearby lymph nodes. The surgeon injecting substance known as a tracer near the tumor to find the sentinel lymph node or nodes. These are the nodes the cancer is most likely to spread to first. 
  • If cancer is found, the lymph nodes in that area will be removed.
  • If cancer is not found, the rest of the lymph nodes are left in place.

Depending on the size and location of the melanoma, surgery may require only a local numbing medicine or general anesthesia.

How is immunotherapy used to treat melanoma? 

Immunotherapies are cancer treatments that help the body’s immune system detect and attack cancer cells. Two types of immunotherapies are commonly used to treat melanoma: 

Immune checkpoint inhibitors

Immune checkpoint inhibitors are a type of immunotherapy used to treat several types of cancer, including melanoma. Some cancer cells can switch off the immune system. Immune checkpoint inhibitors are drugs that prevent this from happening. This allows the immune system to find, unmask and destroy cancer cells. Immune checkpoint inhibitors are used to treat some stage 2 or higher melanoma. These include: 

• Keytruda (pembrolizumab)
• Opdivo (nivolumab)
• Tecentriq (atezolizumab)
• Yervoy (ipilumumab)

Imlygic - a modified virus

Imlygic (talimogene laherparepvec or T-VEC therapy) is a genetically engineered virus that is used to treat recurrent or advanced melanoma. The medication is injected directly into the tumor to stimulate an immune response. 

How is targeted therapy used to treat melanoma?

Targeted therapy is a type of cancer treatment designed to attack or kill cancer cells, while sparing normal cells as much as possible. They target abnormal proteins, receptors or genes that are found in cancer cells or the surrounding tissue. Targeted therapies are used to treat some advanced (stage 3 or 4) melanomas. These include:

• BRAF inhibitors
  • BRAF inhibitors are oral medications that help slow down tumor growth in patients with advanced or recurrent melanoma that test positive for the tumor biomarker called a BRAF V600 mutation.
  • About half of all melanomas have a tumor mutation in the BRAF gene.
  • If your melanoma has a BRAF mutation often you will be treated with both a BRAF inhibitor and a MEK inhibitor. Combining these drugs often works better than either one alone.
  • BRAF inhibitors include:
    • Tafinlar (dabrafenib)
    • Braftovi (encorafenib)
    • Zelboraf (vemurafenib)
• MEK inhibitors
  • MEK inhibitors are oral medications that are given alone or in combination with a BRAF inhibitor to treat melanoma in people with a BRAF V600 mutation.
  • MEK inhibitors include:
    • Mekinist (trametinib)
    • Cotellic (cobimetinib)
    • Mektovi (binimetinib)

How is radiation therapy used to treat melanoma?

Radiation therapy is used in certain circumstances. Most people with melanoma will not receive radiation therapy. 

• Radiation might be used after surgery (known as adjuvant therapy) if there’s a high risk that the melanoma might come back. Radiation may be given to the area where the melanoma was removed or to area where lymph nodes were removed, especially if melanoma was found in the lymph nodes. 
• Radiation might be used to treat melanoma that has come back after surgery, either in the skin or lymph nodes, or to help treat distant spread of the disease.
• In metastatic melanoma, radiation may be used to relieve symptoms that occur when the cancer has spread to the brain or the bones. 

Chemotherapy

Chemotherapy is not typically used to treat early-stage melanoma. It may be used to treat advanced melanomas that returned after treatment with immunotherapy or targeted therapy. Chemotherapy for melanoma may include one or a combination of these medications:

• Dacarbazine (DTIC)
• Temozolomide (an oral form af dacarbazine)
• Paclitaxel or doxetaxel
• Cisplatin or carboplatin

Treatment side effects

Your healthcare team should explain what you should expect from all treatments, including:

• all of the possible risks and side effects of each treatment.
• which side effects may be serious and how to tell. 
• when and who you should call if you experience a side effect.
• what can be done to treat or alleviate each side effect. 

Make sure you let your healthcare team know if you experience any side effects of your treatment. For more information about possible treatment side effects, see our section on Cancer Treatment by Treatment Type. 

Table of targeted and immunotherapies used for melanoma