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Melanoma - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Melanoma. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the skin

The skin is the largest organ in the body. It protects against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D.

The skin is made up of three main layers:

  • The epidermis. The outer layer of skin

  • The dermis. The inner layer of skin

  • The hypodermis. The deep layer of fat

See the Medical Illustrations section for a drawing of these layers.

About melanoma

The deepest layer of the epidermis, located just above the dermis, contains cells called melanocytes. Melanocytes produce the skin’s pigment or color. Melanoma begins when healthy melanocytes change and grow uncontrollably, forming a cancerous tumor. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. Sometimes, melanoma develops from a normal mole a person already has on their skin.

Melanoma can develop anywhere on the body, including the head and neck, the skin under the fingernails, the genitals, and even the soles of the feet or palms of the hands. Melanoma may not be colored like a mole. It may have no color or be slightly red, which is called amelanotic melanoma.

When found early, melanoma can often be cured with surgery. However, melanoma is the most serious form of skin cancer. It can grow deep into the skin, called invasive melanoma. It can also invade lymph nodes and blood vessels and spread to distant parts of the body.

This section focuses on cutaneous melanoma, which is melanoma that first develops in the skin. Melanoma can also develop in the mucous membranes that line the mouth, the gastrointestinal tract, a woman’s vagina, and other locations around the body. Melanoma may also develop in the eye. Learn more about melanoma diagnosed in other parts of the body in these separate sections:

For information about other types of skin cancer, review the section on non-melanoma skin cancers.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to this type of cancer. This fact sheet is available as a PDF, so it is easy to print.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in this type of cancer that provides basic information and areas of research.

The next section in this guide is StatisticsIt helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide. 

Melanoma - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year an estimated 76,380 adults (46,870 men and 29,510 women) in the United States will be diagnosed with melanoma of the skin. Melanoma is the fifth most common cancer among men and the seventh most common cancer in women. Before age 50, more women are diagnosed with melanoma than men. However, by age 65, the rate is more than 2 times higher in men. By age 80, the rate in men is nearly 3 times higher than in women.

Melanoma accounts for about 1% of all skin cancers diagnosed in the United States, but it causes most of the skin cancer deaths. It is estimated that 10,130 deaths (6,750 men and 3,380 women) from melanoma will occur this year. The number of people diagnosed with melanoma has risen sharply over the past 3 decades.

Most people with melanoma are cured by their initial surgery. The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. Among all people with melanoma of the skin, from the time of initial diagnosis, the 5-year survival is 92%. The 10-year survival is 89%.

Overall survival depends on the thickness of the primary melanoma, whether the lymph nodes are involved, and whether there is spread of melanoma to distant sites. Lymph nodes are the small, bean-shaped organs that help fight infection. For very early-stage melanoma that is only located near where it started, 5-year survival is over 98%. Survival for melanoma that has spread to the nearby lymph nodes is 63%. If melanoma has spread to other parts of the body, survival is 17%. However, survival varies depending on a number of factors. These factors are explained in detail in the Diagnosis and Stages sections.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different.

It’s important to know that these statistics are an estimate and do not yet reflect the effects of newer treatments for metastatic melanoma (see the Treatment Options section). The pace of melanoma research is rapid, especially over the last 5 years. Doctors cannot say for sure how long anyone will live with melanoma. Also, experts measure survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers a drawing of the structures that make up the skin. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them to your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing melanoma:

  • Sun exposure. Exposure to ultraviolet (UV) radiation from the sun plays a major role in the development of skin cancer. People who live at high altitudes or in areas with bright sunlight year-round have a higher risk of developing skin cancer. People who spend a lot of time outside during the midday hours also have a higher risk.

    Exposure to ultraviolet B (UVB) radiation from the sun appears more closely associated with melanoma, but newer information suggests that ultraviolet A (UVA) may also play a role in the development of melanoma, as well as the development of basal and squamous cell skin cancers. While UVB radiation causes sunburn and does not penetrate through car windows or other types of glass, UVA is able to pass through glass and may cause aging and wrinkling of the skin in addition to skin cancer. Therefore, it is important to protect your skin from both UVA and UVB radiation (see Prevention below.)

  • Indoor tanning. People who use tanning beds, tanning parlors, or sun lamps have an increased risk of developing all types of skin cancer. Use of indoor tanning beds is strongly discouraged. Recreational sun tanning outdoors should also be avoided to reduce the risk of skin cancer.

  • Moles. People with many moles or unusual moles called dysplastic nevi or atypical moles have a higher risk of developing melanoma. Dysplastic nevi are large moles that have irregular color and shape. A doctor may recommend regular photography of the skin to keep a close eye on people with many moles.

  • Fair skin. People with fair complexion, blond or red hair, blue eyes, and freckles are at increased risk for developing melanoma. This risk is also higher for people whose skin has a tendency to burn rather than tan.

  • Family history. Approximately 10% of people with melanoma have a family history of the disease. If a person has a close relative (parent, brother, sister, or child) who has been diagnosed with melanoma, his or her risk of developing melanoma is 2 to 3 times higher than the average risk. This risk increases if several family members who live in different locations have been diagnosed with melanoma. Therefore, it is recommended that close relatives of a person with melanoma routinely have their skin examined.

  • Familial melanoma. Although changes, called mutations, in specific genes, such as CDKN2A, CDK4, and MITF, have been identified that may lead to melanoma, these are rare and only a very small number of families with a history of melanoma actually pass these genetic mutations from generation to generation. Scientists are looking for other genes and environmental factors that might also affect a person’s risk of developing melanoma and other cancers. Learn more about familial melanoma.

  • Other inherited conditions. People with specific genetic conditions, including xeroderma pigmentosum, retinoblastoma, Li-Fraumeni syndrome, Werner syndrome, and certain hereditary breast and ovarian cancer syndromes, have an increased risk of developing melanoma.

  • Previous skin cancer. People who have already had a melanoma have an increased risk of developing other, new melanomas. People who have had basal cell or squamous cell skin cancer also have an increased risk of developing melanoma. Therefore, people who have had previous skin cancer need ongoing, follow-up care to watch for additional cancers. See the Follow-up Care section for more information.

  • Race or ethnicity. Melanoma rates are about 24 times higher in white people than black people. However, a person of any race or ethnicity can develop melanoma.

  • Age. The median age at which people are diagnosed with melanoma is just above 50 years old. Melanoma occurs in young adults with greater frequency than in many other types of cancer.

  • Weakened or suppressed immune system. People who have weakened immune systems or use certain medications that suppress immune function have a higher risk of developing skin cancer, including melanoma.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Reducing exposure to UV radiation may significantly lower the risk of developing skin cancer. This means reducing exposure to the sun and by avoiding the use of indoor tanning devices. This is important for people of all ages and is especially important for people who have other risk factors for melanoma (see above).

Sun damage builds up over time, so it is important to take the following steps to reduce sun exposure and avoid sunburn:

  • Limit or avoid direct exposure to the sun between 10:00 AM and 4:00 PM.

  • Wear sun-protective clothing, including a wide-brimmed hat that shades the face, neck, and ears. Clothes made from fabric labeled with UV protection factor (UPF) may provide better protection. UV-protective sunglasses are also recommended.

  • Use a broad-spectrum sunscreen throughout the year that protects against both UVA and UVB radiation and has with a sun protection factor (SPF) of at least 30. Reapply at least 1 ounce of sunscreen to your entire body every 2 hours or every hour after heavy perspiration or after being in the water.

  • Avoid recreational outdoor sunbathing.

  • Do not use sun lamps, tanning beds, or tanning salons.

  • Examine your skin regularly. This should include examinations by a health care professional, as well as self-examinations. Learn more about melanoma screening.

Learn more about protecting your skin from the sun.

Getting less exposure to the sun may reduce your body’s production of vitamin D. However, some research suggests less than 15 minutes of sunlight exposure may be enough for most people to produce an adequate amount of vitamin D. People with limited sun exposure should talk with their doctor about how to include good sources of vitamin D in their diet, including the use of supplements. Your levels of vitamin D can be checked through a simple blood test.

The next section in this guide is Screening. It describes the early warning signs of melanoma and how to perform a self-examination. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about the early detection of melanoma. To see other pages, use the menu.

Early detection and recognition of skin cancer are very important. Recognizing the early warning signs of melanoma and doing regular self-examinations of your skin will help find melanoma early, when the disease is more curable. Your doctor may also recommend medical tests based on your risk factors and medical history.

Self-examination

Melanoma can appear anywhere on the body, even on areas that are not exposed to the sun. The most frequent locations for melanoma are the trunk (torso), legs, and arms. However, melanoma can also develop under the fingernails or toenails; on the palms, soles, or tips of fingers and toes; or on mucous membranes, such as skin that lines the mouth, nose, vagina, and anus.

Self-examinations should be performed in front of a full-length mirror in a brightly lit room. It helps to have another person check the scalp and back of the neck. Include the following steps in a self-examination:

  • Examine the front and back of the entire body in a mirror, then the right and left sides, with arms raised.

  • Bend the elbows and look carefully at the outer and inner forearms, upper arms (especially the hard-to-see back portion), and hands.

  • Look at the front, sides, and back of the legs and feet, including the soles and the spaces between the toes.

  • Part the hair to lift it and examine the back of the neck and scalp with a hand mirror.

  • Check the back, genital area, and buttocks with a hand mirror.

Talk with your doctor if your hairdresser or barber has noticed a suspicious skin area, or lesion, on your scalp or beard or if you find any of the following during a self-examination:

  • A growth on the skin that matches any symptom listed in the next section of this guide

  • New growth on the skin

  • A suspicious change in an existing mole or spot

  • A sore that doesn't heal within 2 weeks

Medical tests for early detection

A painless medical technique being used for early detection of melanoma is epiluminescence microscopy, or dermoscopy. Using a handheld device, a doctor can evaluate the patterns of size, shape, and pigmentation in pigmented skin lesions. Among trained, experienced medical professionals, dermoscopy may reduce the number of biopsies (see the Diagnosis section) of pigmented lesions to rule out melanoma, although more research is needed.

Confocal scanning laser microscopy is another new technology that may improve the examination of possible melanoma lesions. Currently, it is only available in a few major facilities.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide. 

Melanoma - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

ABCDE rule

Changes in the size, shape, color, or feel of a mole is often the first warning sign of melanoma. These changes can occur in an existing mole, or melanoma may appear as a new or abnormal-looking mole. The "ABCDE" rule is helpful in remembering the warning signs of melanoma:

  • Asymmetry. The shape of one-half of the mole does not match the other.

  • Border. The edges are ragged, notched, uneven, or blurred.

  • Color. Shades of black, brown, and tan may be present. Areas of white, gray, red, or blue may also be seen.

  • Diameter. The diameter is usually larger than 6 mm (1/4 inch; the size of a pencil eraser) or has grown in size. Melanoma may be smaller when first detected.

  • Evolving. The mole has been changing in size, shape, color, or appearance, or it is growing in an area of previously normal skin. Also, when melanoma develops in an existing mole, the texture of the mole may change and become hard or lumpy. Although the skin may feel different and may itch, ooze, or bleed, melanoma usually does not cause pain.

When to see a doctor

Many melanomas are dark brown/black and are often described as changing, different, unusual, or “ugly looking.” However, any skin abnormality that is growing or changing quickly and does not go away, whether colored or not, should be examined by a doctor. Bleeding may be a sign of more advanced melanoma. In addition, the appearance of a new and unusual mole is more likely to be melanoma.

If you are concerned about a new or existing mole, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If melanoma is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find out whether a suspicious mole or other skin growth is cancerous. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For melanoma, a biopsy of the suspicious skin area, called a lesion, is the only sure way for the doctor to know whether it is cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. The doctor may suggest other tests that will help make a diagnosis and determine the overall stage of the melanoma.

This list describes options for diagnosing melanoma, but not all of the tests listed will be used for every person. Your doctor will consider several factors, explained below, when choosing diagnostic tests for each person.

Biopsy and pathological examination of a skin lesion

Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. Before a biopsy, a health care provider will usually numb the area with a local anesthetic. Then he or she will remove the suspicious skin growth, making sure to preserve the entire lesion so the thickness of the potential cancer and its margin (healthy tissue around the lesion) can be carefully examined.

A pathologist then analyzes the sample(s) removed during the biopsy to figure out if the lesion is a melanoma. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

The pathologist will write a report, called a pathology report, that should include at least the following information:

  • Type/subtype of melanoma

  • Thickness of melanoma

  • How rapidly the cells are dividing, which is called the mitotic rate

  • Presence or absence of ulceration

  • Presence of immune cells called tumor-infiltrating lymphocytes

  • Margin status, which describes whether melanoma cells can be seen at the edges of the biopsy sample

Additional information is described in detail below.

Types of melanoma of the skin

The four most common types of skin, or cutaneous, melanoma are:

  • Superficial spreading melanoma. This is the most common type, accounting for 70% of melanomas. It usually develops from an existing mole.

  • Lentigo maligna melanoma. This type tends to occur in older people. It most commonly begins on the face, ears, and arms, on skin that is chronically exposed to the sun.

  • Nodular melanoma. This type accounts for about 15% of melanomas. It often appears rapidly as a bump on the skin. It is usually black, but it may be pink or red.

  • Acral lentiginous melanoma. This type of melanoma develops on the palms of the hands, soles of the feet, or under the nail bed. It sometimes occurs on people with darker skin. Acral lentiginous melanoma is not related to sun exposure.

Subtypes of melanoma

Melanoma cells are usually classified by histologic types, which are based on how they appear under a microscope. Recent information has shown that melanoma can also be classified into molecular (genetic) subtypes. These molecular subtypes are based on the distinct genetic changes of the melanoma cells. These genetic changes include:

  • BRAF mutations. The most common genetic change in melanoma is found in the BRAF gene, which is mutated in about 50% of cutaneous melanomas.

  • NRAS mutations. NRAS is mutated in the tumors of approximately 20% of patients with melanoma.

  • KIT mutations. These mutations occur more commonly in melanomas that develop from mucus membranes, melanomas on the hands or feet, or melanomas that occur in chronically sun-damaged skin, such as lentigo maligna melanoma. KIT mutations may influence a patient’s treatment options.

Some melanomas do not have mutations in the BRAF, NRAS, or KIT genes. These tumors have other genetic changes that cause them to grow. Researchers are currently trying to target the other mutations found in these tumors in clinical trials.

The classification of melanoma into different subtypes based on genetic changes can have a major effect on treatment options. Targeting specific mutated genes is an important new way of treating invasive melanoma, called targeted therapy. Learn more about targeted therapy in the Treatment Options and Latest Research sections.

Melanoma tumor thickness

The thickness of the primary melanoma tumor is the most reliable characteristic that helps doctors predict the risk that the cancer will spread. To do this, the pathologist will measure from the top of the skin down to the underlying skin.

  • Thin. A melanoma tumor that is less than 1 mm thick is characterized as "thin." A thin melanoma is associated with a low risk of spreading to regional lymph nodes or to distant parts of the body.

  • Intermediate. An intermediate-thickness melanoma is between 1 mm and 4 mm.

  • Thicker. A thicker melanoma, more than 4 mm thick, is associated with a higher chance of recurrence. This is because the cancer has sometimes already spread to other parts of the body at the time of diagnosis. Recurrence is when a cancer comes back after treatment.

Ulceration

The presence or absence of ulceration of the primary melanoma is defined in the pathology report. Ulceration is the loss of the surface of the skin. If the melanoma is ulcerated, research has shown it significantly increases the risk of spread and recurrence.

Mitotic rate

Another pathological feature of melanoma is the mitotic rate, which is an estimate of the speed at which tumor cells are dividing. It is measured as the number of mitoses per millimeter squared (mm2). Combined with the thickness and the presence of ulceration, the mitotic rate is used to help determine the stage, treatment options, and prognosis (see below).

Additional evaluation after a diagnosis of melanoma

After an initial diagnosis of melanoma, you will be referred to a specialist. The doctor will take a complete medical history, noting any symptoms or signs, and perform a complete physical examination, including a total skin examination. This could also include a sentinel lymph node biopsy (see the Treatment Options section). The focus of these examinations is to identify risk factors and signs or symptoms that may indicate melanoma has spread beyond the original site.

The extent of the initial evaluation is based on the primary (original) melanoma’s risk of recurrence. For most low-risk melanomas, such as most people whose melanoma is less than 1 mm thick, no further search for metastases or spread is generally necessary. For people with higher-risk melanoma, more extensive testing, such as lymph node assessment and the other tests described below, may be considered. Therefore, the extent of the initial evaluation for a patient with newly diagnosed melanoma is based on the stage of melanoma and discussions with the team of doctors.

Depending on the results of the evaluation, including the pathology report of the primary melanoma tumor, further testing for high-risk or later-stage melanoma may include the following:

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs, including collections of lymph nodes, called lymph node basins, and soft tissue.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. If melanoma has spread, a CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide

Melanoma - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn about how doctors describe a melanoma’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctors decide what type of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

Factors used for staging melanoma

To determine the stage of a melanoma, the lesion and some surrounding healthy tissue needs to be surgically removed and analyzed using a microscope. Doctors use the melanoma’s thickness, measured in millimeters (mm), and the other characteristics described in the Diagnosis section to help determine the disease’s stage.

Doctors also use results from diagnostic tests to answer these questions about the stage of melanoma:

  • How large is the original melanoma, often called the primary melanoma or primary tumor, and where is it located?

  • Has the melanoma spread to the lymph nodes? If so, where and how many?

  • Has the melanoma metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of melanoma for each person. There are 5 stages of melanoma: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to create the best treatment plan and understand a patient's prognosis.

Here are more details about each stage of melanoma.

Melanoma stage grouping

Stage 0: This refers to melanoma in situ, which means melanoma cells are found only in the outer layer of skin or epidermis. This stage of melanoma is very unlikely to spread to other parts of the body.

Stage I: The primary melanoma is still only in the skin and is very thin. Stage I is divided into two subgroups, IA or IB, depending on the thickness of the melanoma, the mitotic rate, and whether a pathologist sees ulceration under a microscope.

Stage II: Stage II melanoma is thicker than stage I melanoma, extending through the epidermis and further into the dermis, the dense inner layer of the skin. It has a slightly higher chance of spreading. Stage II is divided into three subgroups—A, B, or C—depending on how thick the melanoma is and whether there is ulceration.

Stage III: This stage describes melanoma that has spread through the lymphatic system, either to a regional lymph node located near where the cancer started or to a skin site on the way to a lymph node, called “in-transit metastasis.” The lymphatic system is part of the immune system and drains fluid from body tissues through a series of tubes or vessels. Stage III is also divided into subgroups—A, B, or C—depending on the size and number of lymph nodes involved with melanoma and whether the primary tumor appears ulcerated under a microscope.

Stage IV: This stage describes melanoma that has spread through the bloodstream to other parts of the body, such as distant locations on the skin or soft tissue, distant lymph nodes, or other organs like the lung, liver, brain, bone, or gastrointestinal tract. Stage IV is further divided into M1a, which means the cancer has only spread to distant skin and/or soft tissue sites; M1b, which involves metastasis to the lung; and M1c, which describes distant metastasis at any other location or an elevated serum lactate dehydrogenase (LDH) blood test.

Recurrent: Recurrent melanoma is melanoma that has come back after treatment. If the melanoma does return, there will be a round of tests to learn about the extent of the recurrence. These tests and scans may be similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

The cancer care team

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For a person with melanoma, doctors on this team may include a:

Dermatologist: a doctor who specializes in diseases and conditions of the skin

  • Surgical oncologist: a doctor who specializes in treating cancer with surgery

  • Medical oncologist: a doctor who specializes in treating cancer with medication

  • Radiation oncologist: a doctor who specializes in treating cancer with radiation therapy

  • Pathologist: a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease

Cancer care teams also include a variety of other health care professionals, including physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment overview

Treatment recommendations depend on many factors, including the thickness of the primary melanoma, whether the cancer has spread, the stage of the melanoma, the presence of specific genetic changes in melanoma cells, rate of melanoma growth, and the patient’s other medical conditions. Other factors used in treatment decision making include possible side effects, as well as the patient’s preferences and overall health. Therefore, the following is meant to be an overview and not used as treatment recommendations for specific patients.

Descriptions of the most common treatment options for melanoma are listed below according to the stage of melanoma. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This procedure is usually performed by a surgical oncologist.

Surgery is the primary treatment for people with local melanoma and most patients with regional melanoma. For some people with metastatic melanoma, surgery may also be an option. If surgery is not an option, the melanoma may be called “unresectable.” In recommending a specific treatment plan, doctors will consider the stage of the disease, as well as the person’s individual risk of recurrence.

Types of surgery used to treat local and regional melanoma are:

  • Wide excision. The primary treatment for melanoma is excision, or surgical removal, of the primary melanoma on the skin. The extent of the surgery depends on the thickness of the melanoma. Most melanomas are found when they are less than 1.0 mm thick, and outpatient surgery is often the only treatment needed. A doctor removes the tumor, tissue found under the skin, and some surrounding healthy tissue, called a margin, so that no cancer cells remain.

    If the melanoma is staged as in situ (stage 0), the doctor may remove a margin of skin at least 5 mm (or 0.5 cm) around the cancer. Overall, the width of the margin increases with the thickness of the melanoma, ranging from a 1 cm margin for melanoma measuring up to 1.0 mm to a 2 cm margin for melanoma measuring over 2.01 mm.

    Depending on the site and extent of the surgery, a skin flap or a skin graft may be necessary. A skin flap is created when nearby tissue is moved around to cover the area removed during surgery. A skin graft uses skin from another part of the body to close the wound and reduce scarring.

  • Lymphatic mapping and sentinel lymph node biopsy. This surgical procedure helps the surgeon figure out whether the melanoma has spread to the lymph nodes. During these procedures, the surgeon removes 1 or more lymph nodes near the tumor, called sentinel lymph nodes, to check for melanoma cells. If melanoma cancer cells are not found in the sentinel lymph node(s), no further lymph node surgery is required. If the sentinel lymph nodes contain melanoma, this may be called a positive sentinel lymph node biopsy result. This means the disease has started to spread, and lymph node dissection (see below) is typically recommended.

    These procedures are usually recommended for people with a melanoma that is more than 1.0 mm thick or has ulceration. However, a sentinel lymph node biopsy may also be recommended by a surgical oncologist for some other melanomas that are less than 1.0 mm thick.

    For non-ulcerated melanomas less than 1.0 mm thick, the likelihood that the cancer has spread to the lymph nodes is so low that, in most cases, sentinel lymph node mapping is not necessary. However, sometimes the doctor will recommend this procedure for a person with a thin melanoma if there are other signs that the melanoma is more aggressive, such as ulceration or higher mitotic rate (see the Diagnosis section). If the melanoma is less than 1.0 mm, your doctor will discuss whether this approach is recommended based on other features of the primary melanoma and other factors.

    Sentinel lymph node mapping should be performed during the same procedure as the wide excision because such surgery can change the lymphatic drainage pattern. This may affect the reliability of the procedure in some situations.

  • Lymph node dissection. If melanoma is found in the sentinel lymph nodes, doctors usually recommend removing the remaining lymph nodes in that area with surgery. The number of lymph nodes removed depends on the area of the body. However, research has shown that people who have a complete lymph node dissection after a positive sentinel lymph node biopsy live for the same amount of time as those who are closely watched for signs of cancer. As a result, some people decide not to have a complete lymph node dissection. People who have had a lymph node dissection around an arm or leg have higher risk for fluid buildup in that limb, a side effect called lymphedema.

Sometimes a lymph node is found to be enlarged during a physical exam, after a scan, or during an ultrasound. If this happens, doctors usually recommend having a lymph node dissection. Doctors generally agree it is important to remove all lymph nodes in these situations.  

Talk with your health care team about the possible side effects that may occur based on the specific type of surgery. Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. The radiation beam produced by this machine can be pointed in different directions and blocked using special techniques to help decrease side effects. The radiation oncologist will recommend a specific radiation therapy regimen (schedule) with a total number of treatments and dose of radiation.

General side effects of radiation therapy include skin irritation and fatigue. These usually get better a few weeks after adjuvant radiation therapy is finished. Adjuvant therapy is treatment after the first treatment. Topical corticosteroid creams and antibiotics may be used to help prevent and treat radiation-induced skin reactions.

Depending on the area of the body being treated with radiation therapy, other side effects may develop. For example, after treatment to the head and/or neck region, temporary irritation of the mouth or difficulty swallowing can occur. If treatment was directed at the armpit or groin area, the person may have higher risk of fluid buildup in that limb, a side effect called lymphedema. Lymphedema can be a long-term, ongoing side effect. Talk with the radiation oncologist to learn more about the possible side effects that you may experience and how they can be managed.

Learn more about the basics of radiation therapy.

Adjuvant therapy for stage II and stage III melanoma

After surgery, the surgeon or medical oncologist may recommend adjuvant therapy for patients who are at higher risk for recurrence. Adjuvant therapy is treatment given after the initial treatment to reduce the risk of the melanoma coming back.

Adjuvant treatment options may include radiation therapy, immunotherapy, or joining a clinical trial that is researching new drug treatments (see below and the Latest Research section.)

Adjuvant radiation therapy

Sometimes, radiation therapy is considered after surgery to prevent recurrence. Research has shown that although this may reduce the risk of the melanoma coming back, it does not increase how long a person lives.

People who receive adjuvant radiation therapy experience side effects based on the area treated (see above). In general, a person’s overall quality of life is similar to that of people who do not receive it, according to the results of recent clinical trials. However, some symptoms in the first year were worse for patients receiving adjuvant radiation therapy in those studies.

Adjuvant immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Learn more about the basics of immunotherapy.

The U.S. Food and Drug Administration (FDA) has approved 3 adjuvant immunotherapies for these stages of melanoma: high-dose interferon alfa-2b (Intron A), pegylated interferon alfa-2b (Sylatron), and ipilimumab (Yervoy).

High-dose interferon alfa-2b given over a year has been shown to delay recurrences for some patients. However, it has not been shown to lengthen how long most people live. There are substantial and common side effects to this treatment, including flu-like symptoms, such as fatigue, fever, chills, nausea, vomiting, and headache; rashes; hair thinning; and depression. Because of the side effects and lack of a lengthening of life for most patients who receive this treatment, the use of high-dose interferon is recommended by some but not all doctors who care for melanoma patients.

Pegylated interferon alfa-2b is given by weekly injection for up to 5 years and also has been shown to delay recurrences for some patients. However, it has not been shown to lengthen how long people live. The side effects are very similar to those of high-dose interferon alfa-2b. Because of the side effects and lack of a lengthening of life for most patients treated, the use of pegylated interferon is recommended by some but not all doctors who care for melanoma patients.

Adjuvant ipilimumab for stage III melanoma was approved by the FDA in October 2015. In patients with stage III melanoma, ipilimumab has been shown to delay recurrences for some patients, but it is not yet known whether ipilimumab lengthens life. The side effects of ipilimumab in patients with stage III melanoma are known, however, and the rate of severe, life-threatening, or fatal side effects is approximately 50%. Because of this rate of severe side effects and that it is not yet known whether ipilimumab lengthens life in patients with stage III melanoma, most oncologists do not feel comfortable recommending this treatment for patients with stage III melanoma, although there may be certain situations where this treatment is recommended.

Ipilimumab targets a molecule called cytotoxic T-lymphocyte associated molecule-4 (CTLA4). It works by taking the brakes off the immune system. Because this drug activates the immune system, it can trigger “autoimmune” side effects in which the patient’s own immune system attacks healthy cells in the body. These side effects can be serious and even life-threatening. These side effects include significant colon inflammation (colitis), liver problems, skin reactions, nerve and hormone gland inflammation, and eye problems. Patients are also closely monitored for diarrhea, rashes, itching, and other side effects. Before treatment begins, be sure to talk to your doctor about potential side effects, and let your doctor know right away about any side effects that you experience during treatment. It is also important to tell your doctor about all other medications you are taking, including over-the-counter drugs and dietary or herbal supplements, to avoid possible side effects from drug interactions with ipilimumab. Learn more about this medication and its side effects in this Cancer.Net podcast.

New adjuvant drug treatments

There are many clinical trials underway testing targeted therapies and other immunotherapies after surgery. These include anti-PD1 antibodies and inhibitors of the mutated BRAF protein. See stage IV options and the Latest Research section for more information about these treatment options that may be open for those with stage II or stage III disease.

Systemic treatment options for unresectable stage III and stage IV melanoma

If melanoma has spread to other, distant parts of the body, such as distant lymph nodes or the liver, lung, brain, bone, or gastrointestinal tract, doctors call it stage IV melanoma. The most common distant places melanoma spreads to include the lung, liver, and brain. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Treatment recommendations for people with stage III melanoma that cannot be removed with surgery (called unresectable stage III) and stage IV melanoma are often the same and depend on a number of factors, including:

  • The person’s age and overall health

  • The locations and number of metastases

  • How fast the disease is spreading

  • The presence of specific genetic mutations in the tumor

  • The patient’s preferences

Since 2011, several new drugs have become available for metastatic melanoma. These drugs help shrink melanoma for 12% to 60% of patients and help them live longer. These new drugs are generally divided into 2 groups: immunotherapy and targeted therapy. Immunotherapy, targeted therapy, and other common treatment options for stage IV melanoma are described below. Some of these treatments are available only through clinical trials. See the Latest Research section for more information

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Unresectable stage III and stage IV: Immunotherapy

As explained above, immunotherapy helps boost the body’s natural defenses to fight the cancer. In recent years, there have been major advances in treating stage IV melanoma with immunotherapy. Current options for patients include:

  • Anti-CTLA4 antibody. Ipilimumab is approved by the FDA for the treatment of stage IV melanoma, as well as stage III melanoma that cannot be surgically removed, called unresectable melanoma, and as adjuvant therapy for stage III melanoma.

    There have been 2 clinical trials that showed that people taking ipilimumab had a better chance of survival than people who only received traditional chemotherapy (see below). Ipilimumab has been shown to shrink melanoma for 10% to 15% of patients. Some people with melanoma may benefit from ipilimumab treatment for years. Complete disappearance of melanoma has been observed in some patients, and it seems to be permanent in many such patients.

    Ipilimumab and other anti-CTLA4 antibodies continue to be evaluated in clinical trials. See the Latest Research section for more information.

  • Anti-PD-1 antibodies. There are 2 monoclonal antibodies that block a protein called PD-1 (programmed death-1) have been FDA approved: nivolumab (Opdivo) and pembrolizumab (Keytruda). PD-1 is found on the surface of T-cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. This protein keeps the immune system from destroying the cancer. Because these drugs stop PD-1 from working, the immune system is able to better target melanoma cells. New anti-PD-1 and anti-PD-L1 antibodies are currently being developed.

    Both nivolumab and pembrolizumab have been shown to shrink melanoma for 25% to 45% of patients, depending on when the treatment is given. They also cause fewer side effects than ipilimumab. Because of this, nivolumab and pembrolizumab are now being recommended as a first treatment option for people diagnosed with metastatic melanoma.

  • Combining anti-PD-1 and anti-CTLA4 antibodies. Researchers have been studying combining ipilimumab with nivolumab. This combination appears to produce a higher response rate than either drug alone. However, combining these drugs causes far more side effects. Doctors and researchers do not know yet whether the combination results in better overall survival. In September 2015, the FDA approved the immunotherapy combination of ipilimumab and nivolumab for patients with unresectable stage III or stage IV melanoma.

  • Interleukin-2 (IL-2, aldesleukin, Proleukin). This is a drug that activates T-cells and is sometimes given to patients with metastatic melanoma. However, response rates are quite low, with fewer than 10% of patients experiencing a complete response. A complete response is defined as the disappearance of all signs of cancer as a result of treatment.

    This treatment often has multiple and significant side effects. The most common side effects of IL-2 are low blood pressure, fever, chills, and a condition known as capillary leak syndrome. Capillary leak syndrome occurs when fluids and proteins leak from blood vessels, which can cause very low blood pressure and other dangerous effects. Patients treated with high-dose IL-2 require intensive monitoring by the health care team. IL-2 should be given by an experienced health care team familiar with the side effects of IL-2 treatment.

Unresectable stage III and stage IV: Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Learn more about the basics of targeted treatments.

As explained above and in the Diagnosis section, ongoing research has identified several key pathways and genes involved in the growth and spread of melanoma. These advances now allow doctors to tailor or personalize a patient’s treatment plan based on the melanoma’s genetic abnormalities or mutations.

A major research focus is the development of new drugs that block specific biochemical pathways that melanoma cells need to grow. Currently, targeted therapy for melanoma includes:

  • BRAF inhibitors. The discovery that approximately 50% of melanomas have a mutated or activated BRAF gene has provided an important new direction in the treatment of melanoma. There are 2 drugs that inhibit BRAF, dabrafenib (Tafinlar) and vemurafenib (Zelboraf) have been approved for people with both stage IV and stage III melanoma that cannot be surgically removed. These drugs, taken as a pill, are specifically used when the melanoma tumors have a V600E or V600K mutation in the BRAF gene (see the Diagnosis section). These drugs should not be used by patients without the mutation because it can actually be harmful for them.

    In clinical trials for patients with metastatic melanoma having the mutated BRAF gene, both drugs shrank the tumors in the majority of those patients. Vemurafenib was shown to extend patients’ survival by nearly a year, on average. Dabrafenib’s effect on overall survival was not formally tested. Based on these clinical trials, both drugs are approved for standard use for patients with locally advanced stage III melanoma that cannot be removed by surgery or for patients with stage IV melanoma, if the melanoma has the mutated BRAF gene.

    Side effects of vemurafenib included skin problems, including rashes, hair thinning, thick or dry skin, sun sensitivity, and a less aggressive form of skin cancer called squamous cell carcinoma that can often be treated with minor surgery. Other side effects included joint pain, fatigue, nausea, fever, and hair thinning and curling. Talk with your doctor about what side effects may occur before treatment begins. Dabrafenib seems to have fewer side effects like thick or dry skin and hair thinning, and it almost never causes sun sensitivity.

  • MEK inhibitors. In May 2013, the FDA approved trametinib (Mekinist) for patients with melanoma having a BRAF V600E or V600K mutation and who have been diagnosed with unresectable or metastatic melanoma. This drug, which is taken as a tablet, specifically targets the MEK protein, which is involved in cancer growth and survival. Trametinib was approved based on the results of a clinical study that showed patients with stage IIIC or IV melanoma who took this targeted therapy lived longer without the cancer getting worse than those who received chemotherapy. The side effects of trametinib include an acne-like rash, nail inflammation, itching, dry skin, and diarrhea.

  • Combining BRAF and MEK inhibitors. In May 2014, the FDA approved the combination of trametinib with dabrafenib (see above) for melanoma that cannot be surgically removed or metastatic melanoma with a BRAF V600E or V600K mutation. There have now been 2 clinical trials showing that the combination of dabrafenib and trametinib is associated with better tumor shrinkage rates, delay in tumor growth, and longer life compared to vemurafenib, in 1 study, and dabrafenib, in the other study.

    The most common side effects of treatment with trametinib with dabrafenib include fever, chills, tiredness, rash, nausea, vomiting, diarrhea, abdominal pain, swelling in the hands and feet, cough, headache, joint pain, night sweats, decreased appetite, constipation, and muscle pain. Interestingly, the combination of dabrafenib and trametinib reduces some side effects, when compared to either of the medicines taken separately, including a lower rate of secondary skin cancers and rash.

    In the fall of 2015, the FDA approved a second BRAF and MEK inhibitor combination, which consists of the BRAF inhibitor vemurafenib and the MEK inhibitor cobimetinib (Cotellic). A clinical trial has shown that the combination of vemurafenib and cobimetinib is associated with better tumor shrinkage rates, delay in tumor growth, and longer life compared to vemurafenib. The common side effects with this combination include tiredness, nausea, diarrhea, joint aches, sun sensitivity, rash, fever, liver irritation, and swelling in the hands and feet.

    Because of the improved outcomes and reduced side effects of BRAF and MEK inhibitor combinations compared to BRAF inhibitors alone, it is standard practice to recommend 1 of these 2 approved combinations when targeted therapy is being offered to patients with BRAF mutations.

  • KIT inhibitors. Researchers are also focusing on the development of treatments that target the KIT gene, which is mutated or present in increased numbers (extra copies of the gene) in certain subtypes of melanoma, including lentigo maligna melanoma, mucosal melanoma, and acral lentiginous melanoma. Drugs currently being tested in clinical trials for patients with stage IV, mutated KIT melanoma include dasatinib (Sprycel), imatinib (Gleevec), and nilotinib (Tasigna).

Unresectable stage III and stage IV: Intralesional therapy

In late 2015, the FDA approved the use of talimogene laherparepvec (TVEC) for the treatment of unresectable stage III and stage IV melanoma. TVEC is a herpes virus designed in a laboratory to make an immune-stimulating hormone. This virus can infect and destroy melanoma cells. TVEC also helps stimulate the immune system to destroy other melanoma tumors. During intralesional therapy, TVEC is injected directly into 1 or more melanoma tumors. Since TVEC has not been shown to cause significant shrinkage of non-injected tumors in most people, patients with metastatic disease are not usually offered this treatment. Instead, it is usually offered to patients who have a tumor that can be felt on exam and who have limited metastatic disease (a small number of or small tumors) elsewhere, such as the lungs or liver.

Unresectable stage III and stage IV: Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide.

Traditional types of chemotherapy are still used to treat melanoma, but they are usually no longer used as first-line therapy. First-line therapy is the initial treatment recommended after a cancer diagnosis. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a set number of cycles given over a specific time. A patient may receive 1 drug at a time or combinations of different drugs at the same time. Common drugs used for melanoma include dacarbazine (DTIC-Dome), which is the only FDA-approved chemotherapy for melanoma. Temozolomide (Methazolastone, Temodar) is essentially an oral version of DTIC, and it is used for the treatment of stage IV melanoma.

Both DTIC and temozolomide have been shown to shrink melanoma for approximately 12% to 15% of patients. However, no clinical trials have tested whether these drugs increase how long people with melanoma live after treatment. Both DTIC and temozolomide have a limited number of side effects. Talk with your doctor about possible side effects of these drugs.

Other chemotherapies used to treat melanoma include cisplatin (Platinol), fotemustine (Muphoran), lomustine (CeeNU), the taxanes (a group of drugs that includes docetaxel [Taxotere] and paclitaxel [Taxol]), and vinblastine (Velban, Velsar). Combinations of chemotherapy drugs, such as paclitaxel plus carboplatin or cisplatin combined with vinblastine and DTIC may be used. Some chemotherapy drug combinations may have a higher chance of causing melanoma to shrink, but they also cause more side effects.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, nail changes, loss of appetite, diarrhea, some nerve damage causing changes in sensation, and hair loss. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Unresectable stage III or stage IV: Isolated limb infusion therapy

Sometimes melanoma may spread and appear as a number of tumors that develop in 1 leg or arm. In these situations, there are too many tumors for surgery to be feasible or helpful. A doctor may recommend isolated limb infusion with chemotherapy.

During this treatment, a tourniquet is placed on the arm or leg before high doses of chemotherapy are given. The tourniquet keeps the chemotherapy in the arm or leg and prevents it from being transported throughout the body. Approximately 50% to 80% of tumors located in the area where the chemotherapy is circulated respond to this type of treatment. Tumor shrinkage is usually temporary; however, melanoma may be controlled for a year or more in some patients.

Stage IV: Radiation therapy

As described above, radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Radiation therapy may be used to treat melanoma that has spread in several ways.

Sometimes melanoma that has spread causes symptoms, such as bone pain or headaches, that radiation therapy can help relieve. This is called palliative radiation therapy. For some patients, palliative radiation therapy is given to an entire organ with several small doses of radiation, such as to the entire brain using whole-brain radiation therapy. Other times, one or just a few high doses of radiation therapy are given using a linear accelerator (or "linac" for short), Gamma Knife, CyberKnife, or TomoTherapy units. This is called stereotactic radiosurgery, stereotactic ablative radiation therapy, or stereotactic body radiation therapy. It usually works best for just 1 or a few tumors in the brain or elsewhere in the body.

Radiation therapy may be used when cancer has extensive spread to the lymph nodes or skin and cannot be removed by surgery. Researchers also are testing the effectiveness of combining radiation and medicines for melanoma.

The side effects of radiation therapy depend on the type of radiation therapy given and the area of the body that is being treated. Radiation therapy to the brain can cause fatigue, hair loss, headaches, and nausea. Radiation therapy directed at other parts of the body can cause other specific side effects, such as skin irritation. See the Adjuvant radiation therapy section above and talk with your radiation oncologist for more information.

Stage IV: Surgery

If the melanoma has spread to a single or a few distant parts of the body or has come back after treatment, the surgical removal of cancer may help control the disease. However, if there are too many tumors, surgery may not be helpful.

Stage IV: Treating brain metastases

The brain is one of the most common places to which melanoma spreads. Unfortunately, the presence of brain metastases is linked with a very poor prognosis. Less than 50% of people with melanoma that has spread to the brain live 6 months. Because of this poor prognosis, and because of the perceived difficulty in getting chemotherapy drugs into brain tissue (called the blood-brain barrier), people with melanoma that has spread to the brain have traditionally been excluded from clinical trials. Fortunately, this is beginning to change, and there are clinical trials for patients with melanoma and brain metastases.

Currently, the following treatments may be recommended for melanoma that has spread to the brain:

  • Radiation therapy. High-dose radiation therapy given using stereotactic techniques (see above) is often used when there are only a few metastatic tumors in the brain. These techniques are highly effective for getting rid of existing tumors. However, they do not prevent new tumors from developing. The entire brain can be treated with radiation therapy, called whole-brain radiation therapy. However, because the dose of radiation used to treat the entire brain is lower, this type of treatment usually does not shrink tumors.

  • BRAF inhibitors. For people with melanoma that has a BRAF mutation, drugs such as dabrafenib and vemurafenib may be recommended. These drugs easily penetrate into the brain. Clinical trials have shown that melanoma tumors in the brain respond approximately 40% to 50% of the time.

  • Immunotherapy. Ipilimumab, nivolumab, and pembrolizumab are currently being used in clinical trials to treat people with melanoma that has spread to the brain.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem, so it can be addressed as quickly as possible. Learn more about palliative care.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the melanoma does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another part of the body (distant recurrence).

When this occurs, a cycle of testing will begin to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, immunotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Melanoma - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with melanoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that it is the only way to make progress in treating melanoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with melanoma.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for melanoma, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about melanoma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. This section is not meant to be a complete list of new clinical trials since this field is changing rapidly. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Enhanced prevention and early detection methods. There is ongoing research on better prevention and early detection strategies for melanoma. Both primary and secondary prevention are important. Primary prevention involves keeping melanoma from developing, such as reducing exposure of ultraviolet (UV) radiation from the sun and avoiding the use of indoor tanning devices. Secondary prevention includes methods of early detection. One promising area is the screening of people with a high risk of developing melanoma.

  • Targeted therapy. As discussed in the Treatment Options section, targeted therapy is a treatment that targets specific genes or proteins. Ongoing research has identified a number of molecular pathways and activated or mutated genes in melanoma. Clinical trials are testing new drugs to inhibit the MAP kinase pathway and other pathways that melanoma might use to grow and spread. Strategies to prevent the melanoma from becoming resistant to treatment are also being tested such as using combinations of drugs or exploring new schedules of giving drugs to patients.

  • Immunotherapy. Researchers are studying new checkpoint inhibitors and immunotherapies directed at other parts of the immune system. These include TIM3 inhibitors, LAG3 inhibitors, OX40 agonists, CD137 agonists, GITR agonists, and IDO inhibitors. Also, a number of combinations of immunotherapies are being looked at, including all of the above agents with anti-PD-1 or anti-PD-L1 antibodies, as well as combinations of targeted therapies with anti-PD-1 or anti-PD-L1 antibodies.

  • Adoptive cell transfer (ACT). Another type of experimental immunotherapy involves altering a person’s white blood cells, known as lymphocytes, in a laboratory. This is done to increase their ability to fight the tumor. The changed cells are given back to the patient, often in combination with interleukin-2 or other immunotherapies. These types of treatments are known as adoptive cell transfer (ACT).

  • Vaccines. Therapeutic vaccines that may improve the specific immune response to melanoma have been the focus of multiple clinical trials. Melanoma peptide vaccines are being evaluated in clinical trials for patients with both localized and advanced melanoma. Research has shown that vaccination can cause the immune system to fight melanoma, even in advanced disease, but these therapies are still considered experimental. The vaccines are made using certain proteins found only on a melanoma tumor and are given as an injection. The person’s immune system then recognizes the proteins and destroys melanoma cancer cells. To date, no vaccines have shown clinical benefit in patients. Learn more about cancer vaccines.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current melanoma treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding melanoma, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Review research announced at recent scientific meetings about advances in the treatment of melanoma, especially for metastatic disease, by reading these easy-to-understand summaries.

  • Listen to a short podcast led by an ASCO expert in melanoma.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note this link takes you to a separate ASCO website.

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for melanoma are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

If your treatment included lymph node dissection and/or radiation therapy under the arm or in the groin, fluid buildup in the affected limb, called lymphedema, is possible. Graduated support garments, special massages, and other therapies help manage the condition.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with melanoma. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after melanoma treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with melanoma doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care or surveillance and monitoring.

This plan may include regular physical and dermatologic (skin) examinations and/or medical tests to monitor your recovery for the coming months and years. The purpose of monitoring is to look for a recurrence or spread of the disease, as well as a new primary melanoma. The follow-up and surveillance program for a person with a history of melanoma is based on a person’s risk of recurrence, is highly individualized, and can vary from person to person. The most important parts of this surveillance are your medical history and physical exams. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

In general, physical and skin examinations are performed every 3 to 6 months for the first 2 to 3 years and then once a year after that. However, your doctor may recommend a different follow-up schedule. A chest x-ray, CT scan, MRI, and/or PET/CT scan may be recommended if the melanoma has a higher chance of coming back. For people treated for early-stage disease, scans are not generally recommended during follow-up care.

Preventing and detecting second skin cancers

Routine screening with a skin examination for a new melanoma and non-melanoma skin cancer is a necessary part of follow-up care, as is sun protection and sun avoidance. Screening for melanoma and other skin cancers may include mole mapping (photography of the moles) by a doctor or other health care professional. If possible, you should ask your doctor for copies of your photographs and learn how to perform a skin self-examination. There is growing evidence that individuals who are followed using photographs are diagnosed at an earlier stage of melanoma.

Protecting your skin from UV radiation is important to help prevent second skin cancers, either melanoma or non-melanoma skin cancer. Many people who are treated for melanoma lead an active, outdoor lifestyle. It is important to take steps to protect yourself from further skin damage. You can protect against further sun damage by:

  • Participating in outdoor activities before 10:00 AM or after 4:00 PM

  • Wearing long sleeves and pants

  • Using a broad-spectrum sunscreen with an SPF of at least 30

  • Wearing UV-protective sunglasses

  • Wearing a hat

A major consideration following diagnosis and treatment of melanoma is adjusting a person’s lifestyle to use sun-protective or sun-avoidance measures at all times, as well as avoiding indoor tanning devices. In addition, if a person works in an area where there is high UV exposure, there may be job-related issues to consider. Learn more about protecting your skin from the sun.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

For an early-stage, thin melanoma, the surgery is most often outpatient surgery with little need for rehabilitation. With a thicker melanoma and possible skin grafts, depending on the location, there may be some need for rehabilitation following treatment. As explained in the Side Effects section, some patients experience lymphedema or chronic pain. Talk with your doctor about how these can be managed.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.

  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from melanoma are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, managing stress, and protecting your skin from the sun. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-Up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Melanoma - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type or subtype of melanoma do I have?

  • Can you explain my pathology report to me?

  • What stage is the melanoma? What does this mean?

  • What is the depth of the melanoma in millimeters?

  • Is the melanoma ulcerated?

  • Does the melanoma have mitotic activity?

  • Is it likely that the melanoma has spread? Why or why not?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment option, both in the short term and the long term? Is there anything we can do to prevent them?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will each treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery do you recommend?

  • Should I have a sentinel lymph node biopsy to find out if there is spread to the lymph nodes?

  • Will surgery be able to remove all of the cancer? Will I need additional surgery?

  • How long will the operation take?

  • How long will I be in the hospital?

  • After the surgical removal of the melanoma, will I need a skin graft?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

  • Will I need to have additional treatment after surgery?

Questions to ask about having adjuvant or systemic treatment

  • What type of treatment is recommended?

  • Does my melanoma have a BRAF mutation or other known mutation? Is targeted therapy or immunotherapy an option?

  • What is the goal of this treatment?

  • How long will it take to have this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

Questions to ask about stage III melanoma

  • How many lymph nodes are affected with melanoma?

  • Will the rest of the lymph nodes be removed? If yes, what are the potential complications of lymph node surgery?

  • Has the melanoma spilled out of the lymph node? This is called extranodal extension of the melanoma. What does this mean for my treatment?

  • Is radiation therapy or other treatment recommended after surgery?

  • What are the goals of each treatment? What is my prognosis?

  • Where has the melanoma spread? Is a brain scan or PET scan necessary to determine where it has spread?

  • Is surgical removal of the metastases an option, especially if 1 or 2 tumors are present? If so, what are the benefits and risks?

  • What are the goals of each treatment? What is my prognosis?

  • How will side effects and symptoms be prevented and managed to reduce my discomfort and increase my quality of life?

Questions to ask about stage IV melanoma

  • Where has the melanoma spread? Is a brain scan or PET scan necessary to determine where it has spread?

  • Is surgical removal of the metastases an option, especially if 1 or 2 tumors are present? If so, what are the benefits and risks?

  • What are the goals of each treatment? What is my prognosis?

  • How will side effects and symptoms be prevented and managed to reduce my discomfort and increase my quality of life?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms? What steps can I take to reduce the risk of developing a new melanoma or other type of skin cancer?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

  • Are my family members at a higher risk for developing melanoma?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Melanoma - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Melanoma. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Melanoma. Use the menu to select another section to continue reading this guide.