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Melanoma

Melanoma treatments

Treatment for melanoma may include surgery, radiation therapy, chemotherapy, immunotherapy or targeted therapy, either alone or in combination. Your treatment plan generally depends on how early the disease was diagnosed and whether it has spread. Our team of cancer experts will help you choose treatment options tailored to your diagnosis and needs. Common treatments for melanoma include:

Chemotherapy

Chemotherapy may be recommended for patients with metastatic melanoma that has spread to distant parts of the body. Chemotherapy may be used in combination with other cancer treatments, including immunotherapy and surgery.

Regional chemotherapy or isolated limb infusion may be recommended in some cases of limb-affected melanomas, when tumors are found on one of the extremities, such as a leg or an arm. In these situations, isolated limb infusion administers chemotherapy directly to the affected limb, to treat the tumor and help prevent the chemotherapy from traveling elsewhere in the body. By concentrating the chemotherapy on the affected area, this technique may cause fewer side effects than systemic chemotherapy. In this procedure, a tourniquet is placed on the arm or leg, then high doses of chemotherapy are administered.

Immunotherapy

Immunotherapy drugs may be used as a first-line treatment for melanoma and some other cancers, or they may be used in combination with other treatments, such as chemotherapy and surgery. Several types of immunotherapy may be options to treat melanoma, including:

Checkpoint inhibitors: The U.S. Food and Drug Administration (FDA) has approved certain checkpoint inhibitor drugs, which work by targeting signaling proteins that allow cancer cells to hide from the immune system, to treat some cases of advanced or metastatic melanoma. Others have been approved to be used in combination to treat some cases of advanced melanoma.

Cytokines: Some cytokines may be used to treat specific cases of advanced melanoma, or to treat patients who have had surgery to remove cancer that has spread to the lymph nodes. These drugs are designed to stimulate the rapid growth and activity of immune cells.

Oncolytic virus therapy: Certain therapies that use modified versions of harmful viruses to trick the immune system into launching an attack may be used to treat some cases of melanoma on or under the skin, or in the lymph nodes. The modified viruses are injected directly into melanoma lesions or lymph nodes over several weeks or months.

Radiation therapy

Radiation therapy may be used for patients with advanced melanoma. The specific therapies that are used to treat melanoma include:

  • External beam radiation therapy is a painless outpatient procedure that carries none of the standard risks or complications associated with major surgery for melanoma, and no risk of radioactivity to you or to others with whom you have contact.
  • Intensity modulated radiation therapy may help melanoma patients reduce the risk of recurrence and finish treatments more quickly.
  • TomoTherapy® targets hard-to-reach melanoma tumors and lessens treatment-related side effects by helping to reduce damage to nearby healthy tissue.

Surgery

Surgery is the primary treatment for localized melanoma and may be a treatment option for melanoma that has metastasized. For some localized melanomas, surgery may be the only treatment that is necessary. Melanoma may require more extensive surgeries, however, if nearby lymph nodes are enlarged and the doctor suspects cancer cells have spread. Surgical procedures for melanoma include:

Excision: The surgeon performs an excision with a scalpel, cutting the growth off the skin. The patient may receive local anesthesia to numb the affected area. A wide excision is typically used on melanomas. In a wide excision, the skin tumor and a wider perimeter of healthy tissue is removed. A wide excision may also extend more deeply into the skin than a simple excision.

Reconstructive surgery: Skin cancer surgeries may result in scarring or disfigurement, especially in cases when a wide excision or other extensive surgery is necessary to remove a skin cancer, or when the surgery is performed on the face, head, neck or hands. Consult your doctor about your reconstructive surgery options.

Lymph node biopsy and removal: A lymph node biopsy is frequently performed on melanoma patients. In this procedure, your doctor will remove one or more lymph nodes, known as sentinel lymph nodes, which directly receive the lymph fluid draining from the tumor. If no sign of cancer is found in the lymph node or nodes, no additional lymph node surgery is necessary. If melanoma cells are found in one or more sentinel lymph nodes, the remaining lymph nodes in the region may be removed.

Sentinel lymph node biopsy: For patients with melanoma, a special type of lymph node biopsy, known as a sentinel lymph node, is frequently performed. In this procedure, your doctor will remove one or a few specific lymph nodes, known as the sentinel lymph nodes, which are most likely to receive the lymph fluid draining from the tumor. If the sentinel lymph node shows no sign of cancer, then no additional lymph node surgery is necessary. If melanoma cells are found in one or more sentinel lymph nodes, then the remaining lymph nodes in the region are usually removed. A sentinel lymph node biopsy for melanoma is a less invasive procedure than a traditional lymph node dissection, and is typically associated with fewer side effects, such as lymphedema.

Surgery for metastatic melanoma: Melanoma may travel to the brain, bones, liver and lungs. When that occurs, surgery may be performed to remove tumors from these locations. Surgery to treat metastatic melanoma may be combined with other treatments, such as immunotherapy or chemotherapy. In some cases, surgery for metastatic melanoma may be recommended to relieve symptoms of the disease.

Targeted therapy

The FDA has approved several targeted therapy drugs to treat advanced metastatic melanoma that cannot be removed with surgery. Some targeted therapy drugs are used together to treat metastatic melanoma or melanoma that cannot be treated with surgery.

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