Treatment

The treatment of melanoma depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The team may include a surgical oncologist (a doctor who specializes in treating cancer with surgery), a medical oncologist (a doctor who specializes in treating cancer with medication), a radiation oncologist (a doctor who specializes in giving radiation therapy to treat cancer), a dermatologist (a doctor who specializes in diseases and conditions of the skin), and a pathologist.

This section outlines treatments that are the standard of care (best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Descriptions of the most common treatment options for melanoma are listed below.

Surgery

Melanoma can often be successfully treated if it is diagnosed and treated when the tumor is relatively thin. Most melanomas are found when they are thin (less than 1.0 mm) and when outpatient surgery is often the only treatment needed. A doctor will remove the tumor and some healthy tissue around it to make sure no cancer cells remain. The amount of normal tissue removed depends on the thickness of the melanoma. If the melanoma has grown deep into the skin, lymph nodes near the tumor may be removed and examined for cancer cells. Sometimes, the doctor may recommend a sentinel lymph node biopsy (see below). This may be an outpatient procedure or require an overnight stay in the hospital.

Typically, the complete surgical removal of the melanoma requires the removal of 1.0 centimeters (cm) (3/8 of an inch) to 2.0 cm (3/4 of an inch) of normal-appearing skin surrounding the melanoma in all directions, called the margin. In addition, the underlying fat tissue is removed. The specific size of the margin taken depends on the size, stage, and possibility that the melanoma may grow and spread. If it is staged as melanoma in situ (Stage 0), a margin of between 0.5 cm to 1.0 cm may be recommended. In general, a thin melanoma (measuring 1.0 mm or smaller in thickness) can be safely removed with a 1.0 cm margin of skin, while a thicker melanoma requires a 2.0 cm margin of skin.

Depending on the site of the surgery, a skin graft (a procedure using the skin from another part of the body to both close the wound and reduce scarring) may be necessary. Since melanoma surgery for primary melanoma is usually limited to the removal of the skin and subcutaneous tissues, rehabilitation is rarely necessary for this procedure.

Lymphatic mapping and sentinel lymph node biopsy. This surgical procedure is used to determine if the melanoma has spread to regional lymph nodes. During the procedure, the doctor removes one or a few sentinel lymph nodes to check for cancer cells. A sentinel lymph node is the first node into which the lymph system drains from the primary melanoma site. If cancer cells are detected in the sentinel lymph node, it means that the disease has spread to the regional lymph nodes. Other lymph nodes in the region are also at risk for spread.

Lymph node dissection. When melanoma has spread to lymph nodes, surgical removal of the remaining lymph nodes in that region is usually recommended. The number of lymph nodes removed depends on the area of the body, and the likelihood of finding additional lymph nodes that contain melanoma is determined based on the stage of the melanoma. People who have had a lymph node dissection around an arm or leg have higher risk for fluid build-up in that limb, a side effect called lymphedema (see Side Effects). In general, the risk of spread to areas of the body beyond the regional lymph nodes is greater for patients who have lymph nodes containing melanoma than for patients whose lymph nodes do not contain disease.

If the melanoma has spread to distant organs (Stage IV) or recurs (comes back after treatment), surgery may be a treatment option to help control the disease.

After surgery, the surgeon or medical oncologist may also recommend adjuvant treatment (treatment given after the primary treatment) based on the information that was learned about the disease during surgery. This may include immunotherapy, chemotherapy, and/or radiation therapy; see more information below on each treatment.

Learn more about cancer surgery.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune function. Immunotherapy works well to treat melanoma, particularly to reduce the risk that the melanoma will come back. Immunotherapy may be used in combination with surgery and/or chemotherapy, or as part of a clinical trial. Many immunotherapies are being evaluated for melanoma in clinical trials.

Only one adjuvant therapy has been shown to consistently reduce the likelihood of a recurrence of melanoma. This treatment is called high-dose interferon alfa-2b. It is given intravenously (injected into a vein) in the doctor’s office for 20 doses (five days a week, for four weeks) in the first month, and then under the skin three times a week at home for 11 months. It has been shown to reduce recurrence and, in two clinical trials, has greatly increased survival. This is the only therapy that is currently approved as adjuvant therapy, except as part of a clinical trial. Adjuvant therapy for melanoma is often recommended when the primary melanoma is found at a later stage or if it has spread to the lymph nodes.

Interleukin-2 (IL-2) is another type of immunotherapy used to treat melanoma. High-dose IL-2 treatment is used for patients when cancer has spread where it cannot be removed with surgery. In clinical trials, the therapy does not significantly increase a patient's life span, but it delays the time it takes for cancer to come back after treatment. A few patients have had long-term disappearance of detectable melanoma with this approach.

Some cancer centers offer experimental vaccines to treat melanoma. These are now being tested for advanced disease, in the hopes that a vaccine could help prevent melanoma recurrence similar to treatment with interferon alfa-2b. 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 these proteins and destroys the cancer cells. Another type of experimental immunotherapy involves altering the patient’s lymphocytes (white blood cells) in the laboratory to increase their ability to fight the tumor. The changed cells are given back to the patient, often in combination with chemotherapy. These types of treatments are only available as part of a clinical trial.

Side effects of these treatments vary widely. They can include fatigue, fever, chills, headache and some memory difficulties, muscle ache, and skin irritation. Occasionally, immunotherapy can cause a change in blood pressure or increased fluid in the lungs. Side effects of immunotherapy can be greater than or less than side effects from other types of treatment. Patients should discuss the benefits and risks of each treatment option with their doctors.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. It is given by a medical oncologist. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.

For melanoma, chemotherapy is typically used to control advanced disease, although the cure of widespread melanoma is rare. Systemic chemotherapy used for melanoma include dacarbazine (DTIC-Dome), carboplatin (Paraplat, Paraplatin), cisplatin (Platinol), and temozolamide (Methazolastone, Temodar). There are several combinations of chemotherapy that are currently being tested in clinical trials, and new drugs that specifically stop melanoma from growing are also being studied.

In addition to systemic chemotherapy, there are also chemotherapy techniques that focus on a specific region. If melanoma has spread only on one limb (an arm or a leg), isolated limb perfusion (ILP) is an approach that uses surgery and chemotherapy. First, a surgeon separates the limb’s blood circulation from the rest of the body. Then, a high dose of chemotherapy is injected into the limb’s bloodstream to kill cancer cells. Isolated limb infusion (ILI) is similar to ILP, but in order to isolate the limb’s blood circulation from the rest of the body, pressure is applied above the area using a tourniquet. Then, a high dose of chemotherapy is injected into the major blood vessels entering and leaving the limb. ILP/ILI may use melphalan (Alkeran).

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

Learn more about 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.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Radiation therapy for melanoma can be used in several ways. Radiation therapy is most commonly used to relieve symptoms caused by melanoma that has spread, especially to the brain and bones. It may also be used when cancer has spread to the lymph nodes, following a lymph node dissection (see above). Radiation therapy is also used when the amount of melanoma that can be removed with sugery is limited by the location of the tumor. And, research is being done to test the effectiveness of chemoradiation, a combination of radiation therapy and chemotherapy, to treat melanoma.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. A patient may experience hair loss if radiation therapy is used on the scalp. If radiation therapy is used around the head and neck, side effects, such as a change in taste and dry mouth, may occur. Most side effects go away soon after treatment is finished. If lymph nodes near an arm or leg were affected, the person may have higher risk of fluid build-up in that limb, a side effect called lymphedema. Lymphedema can be a long-term, ongoing side effect. Learn more about radiation therapy and managing side effects.