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Treating Hereditary Melanoma

Q: How do doctors decide on a treatment plan?

Doctors base their treatment plan for melanoma on the stage, type and location of the disease. Tumor biomarker testing and genetic testing can provide additional clues about which treatments may work best for your cancer. For people with metastatic or advanced cancer, these additional tests are usually recommended. Treatment may include a combination of surgery, radiation, targeted therapy and immunotherapy. Chemotherapy is sometimes used of the cancer returns after these treatments. Clinical trials may be available for any stage of cancer.

Q: How are targeted therapies 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)

Q: How is chemotherapy used to treat melanoma?

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

Learn about national guidelines and treatment options for people with hereditary melanoma.

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How do doctors decide on a treatment plan?

Doctors base their treatment plan for melanoma on the , type and location of the disease. Tumor testing and genetic testing can provide additional clues about which treatments may work best for your cancer. For people with or advanced cancer, these additional tests are usually recommended.

Treatment may include a combination of surgery, radiation, and . Chemotherapy is sometimes used of the cancer returns after these treatments. Clinical trials may be available for any of cancer.

Table of targeted and immunotherapies

More resources

How is surgery used to treat 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 . 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 in that area will be removed.
- If cancer is not found, the rest of the 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 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 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 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 are targeted therapies used to treat melanoma?

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 ( 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 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)

Table of immunotherapies and targeted therapies for melanoma

Name of Drug	Cancer	Indication		Type of Agent
Braftovi (encorafenib)	Unresectable or melanoma	Combined with Mektovi (binimetinib), for the treatment of people with unresectable or melanoma	BRAF V600E or V600K tumor mutation	BRAF inhibitor (type of kinase inhibitor)
Cotellic (cobimetinib)	Unresectable or melanoma	Combined with Zelboraf (vemurafenib) for the treatment of people with unresectable or melanoma	BRAF V600E or V600K tumor mutation	BRAF inhibitor (type of kinase inhibitor)
Mekinist (trametinib)	Unresectable or melanoma	As a single agent and in combination with dabrafenib for the treatment of unresectable or melanoma	BRAF V600E or V600K tumor mutation	MEK inhibitor (type of kinase inhibitor)
Mekinist (trametinib)	Lymph node positive	Combined with Taflinar (dabrafenib) as treatment of people with melanoma and involvement of lymph node(s), following complete resection	BRAF V600E or V600K tumor mutation	MEK inhibitor (type of kinase inhibitor)
Mektovi (binimetinib)	Unresectable or melanoma	Combined with Braftovi (encorafenib), for the treatment of people with unresectable or melanoma	BRAF V600E or V600K tumor mutation	MEK inhibitor (type of kinase inhibitor)
Tafinlar (dabrafenib)	Unresectable or melanoma	Combined with Mekinist (trametinib) for the treatment of people with unresectable or melanoma	BRAF V600E or V600K tumor mutation	BRAF inhibitor (type of kinase inhibitor)
Tafinlar (dabrafenib)	Lymph node positive	Combined with Mekinist (trametinib) as treatment of people with melanoma and involvement of lymph node(s), following complete resection	BRAF V600E or V600K tumor mutation	BRAF inhibitor (type of kinase inhibitor)
Zelboraf (vemurafenib)	Unresectable or melanoma	Combined with Tecentriq (atezolizumab) and Cotellic (cobimetinib) in people with melanoma that has the BRAF gene mutation, when the cancer can’t be removed by surgery or has spread to other parts of the body	BRAF V600E or V600K tumor mutation	BRAF inhibitor (type of kinase inhibitor)
Tecentriq (atezolizumab)	or unresectable melanoma	Combined with Cotellic and Zelboraf in people with melanoma that has the BRAF gene mutation, when the cancer can’t be removed by surgery or has spread to other parts of the body	BRAF V600E or V600K tumor mutation	Type of known as an immune checkpoint inhibitor
Keytruda (pembrolizumab)	or unresectable melanoma	For the treatment of people with melanoma	No required	Type of known as an immune checkpoint inhibitor
Opdivo (nivolumab)	or unresectable melanoma	As a single agent or combined with ipilimumab	No required	Type of known as an immune checkpoint inhibitor
Opdivo (nivolumab)	or lymph node positive melanoma	For the treatment of people with following complete removal of the cancer	No required	Type of known as an immune checkpoint inhibitor
Yervoy (ipilumumab)	or unresectable melanoma	For the treatment of people with melanoma	No required	Type of known as an immune checkpoint inhibitor
Yervoy (ipilumumab)	Lymph node positive melanoma	treatment of people with cutaneous melanoma with spread to regional of more than 1 mm who have undergone complete removal of the cancer and	No required	Type of known as an immune checkpoint inhibitor
Imlygic (T-VEC or talimogene laherparepvec)	Unresectable recurrent melanoma	For local treatment of cutaneous, subcutaneous, and lymph node lesions in people with melanoma that came back after initial surgery	No required	Cancer vaccine

How is radiation therapy used to treat melanoma?

Most people with melanoma do not need to receive radiation therapy. Radiation therapy may be most helpful in the following situations:

Radiation might be used after surgery (known as 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 were removed, especially if melanoma was found in the .
Radiation might be used to treat melanoma that has come back after surgery, either in the skin or , or to help treat distant spread of the disease.
In melanoma, radiation may be used to relieve symptoms that occur when the cancer has spread to the brain or the bones.

How is chemotherapy used to treat melanoma?

Chemotherapy is not typically used to treat melanoma. It may be used to treat advanced melanomas that returned after treatment with or . 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.