Melanoma treatment varies depending on the cancer’s stage. The main treatment option for melanoma is surgery. Doctors can use other approaches to kill remaining cancer cells after surgery or to treat people for whom surgery isn’t an option.

In this article, we’ll go over several treatment options used for melanoma skin cancer. If you have questions about your specific melanoma treatment plan, talk to your oncologist (cancer specialist). They can also help you manage any treatment side effects you may experience.

Surgery

Most people with melanoma will have surgery at some point in their treatment journey. For those with early-stage (stages 1 and 2) melanoma, surgery can usually cure their cancer. The type of surgery your oncologist chooses depends on how large the tumor is and where it’s located.

Melanoma is diagnosed with a biopsy — a procedure that removes a tissue sample to look at under a microscope. Surgeons take some of the tumor during a biopsy, but more surgery is likely needed to completely remove it.

Wide excision surgery removes the tumor along with tissue from a margin or area surrounding the tumor. This helps make sure no melanoma cells are left behind. Mohs surgery — or Mohs micrographic surgery — is a procedure sometimes used to treat melanoma in areas where a wide excision would be difficult. It involves removing thin layers of skin and examining them with a microscope until only cancer-free tissues remain. Some studies show it may be useful for treating early-stage melanoma, but not all doctors agree on its use.

Melanoma can also spread into nearby lymph nodes. These tiny organs filter out infections and cancer cells. Oncologists may biopsy or remove lymph nodes as needed to treat melanoma. This helps stop melanoma from spreading to other places in the body.

Immunotherapy

Immunotherapy uses lab-made protein drugs to activate the body’s immune system against cancer. The U.S. Food and Drug Administration (FDA) has approved several immunotherapy drugs for treating melanoma.

Immunotherapy may be used to treat stage 2, 3, and 4 melanoma. Oncologists can give immunotherapy on their own or as a treatment after surgery — known as adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells left behind after surgery. It helps reduce the chances of melanoma returning.

Immune Checkpoint Inhibitors

Some people have melanomas that make specialized proteins that help them hide from the immune system. These proteins work as an “off switch,” turning off immune cells known as T cells. If the T cells are switched off, they’re unable to identify cancer cells to eliminate them from the body. As a result, the melanoma tumors can keep growing and spreading.

Doctors and researchers have developed medication known as immune checkpoint inhibitors (ICIs). They work by blocking the “off switch” proteins, allowing T cells to attack and destroy melanoma cells. There are several FDA-approved ICIs for advanced melanoma, including:

• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Nivolumab and relatlimab-rmbw (Opdualag)
• Pembrolizumab (Keytruda)

Oncolytic Virus Therapy

Oncolytic virus therapy is another type of immunotherapy that may be used for melanoma. An oncolytic virus is a lab-engineered virus that specifically attacks and kills cancer cells. It’s important to note that the virus won’t attack your body’s healthy cells.

The FDA has approved talimogene laherparepvec (T-VEC, sold as Imlygic) for treating advanced melanoma. Specifically, it’s used to treat melanoma that can’t be fully removed with surgery. T-VEC is injected directly into melanoma tumors found on the skin, underneath the skin, or within lymph nodes. The virus enters the melanoma cells and begins replicating (making more copies of itself). Eventually, the melanoma cells burst open and die, and the tumor shrinks.

Interferon Alfa-2B

Interferons are immune system proteins that help activate your immune system to fight off invading bacteria and viruses. Doctors and researchers have found that interferon injections can also help boost the immune system to fight and destroy melanoma cells.

Oncologists use interferon as an adjuvant treatment for people with high-risk melanoma. Specifically, this means that their melanoma tumors are deep and thick or have spread to nearby lymph nodes. Interferon treatment helps kill or slow the growth of any tumor cells that may be left behind from surgery.

The FDA has approved two interferon drugs for melanoma — high-dose interferon alfa-2b (Intron A) and pegylated interferon alfa-2b (Sylatron).

Tebentafusp-Tebn

Scientists are always finding new ways to treat diseases. In 2022, the FDA approved tebentafusp-tebn (Kimmtrak). Specifically, tebentafusp-tebn is used to treat uveal melanoma (affecting the eyes) that can’t be treated with surgery or has spread to other parts of the body.

Tebentafusp-tebn is an engineered protein with two parts. One part attaches to melanoma cells, and the other attaches to T cells. This connection helps the immune system attack and destroy melanoma tumors.

You’ll need to have testing first to make sure tebentafusp treatment will work for you.

Interleukin-2

Interleukins (ILs) are inflammatory proteins normally made by your immune system. An IL-2 called aldesleukin (Proleukin) is an immunotherapy that can help activate the immune system to fight stage 4 melanoma, also known as metastatic melanoma.

Studies show that IL-2 may not be the most effective treatment for some people. With more immunotherapy options available, it’s not widely used anymore.

Targeted Therapy

Targeted therapies work by “targeting” or blocking abnormal proteins made by melanoma cells. According to the American Cancer Society, around 50 percent of melanomas have mutations or changes in the BRAF gene. BRAF proteins work together with MEK proteins to send growth signals in cells. By blocking these proteins in melanoma cells, targeted therapies help shrink tumors.

The FDA has approved several targeted therapies for melanoma. These medications are used to treat melanoma that has spread or can’t be removed with surgery. BRAF inhibitors for melanoma include:

• Dabrafenib (Tafinlar)
• Encorafenib (Braftovi)
• Vemurafenib (Zelboraf)

Examples of MEK inhibitors include:

• Binimetinib (Mektovi)
• Cobimetinib (Cotellic)
• Trametinib (Mekinist)

Studies show that BRAF and MEK inhibitors work best when they’re used together in specific combinations. For example, dabrafenib and trametinib can be used as an adjuvant treatment for people with stage 3 melanoma. This helps prevent the cancer from returning.

Targeted therapies can also be combined with immunotherapy. A combination of atezolizumab, cobimetinib, and vemurafenib can be used to treat melanoma with BRAF V600 mutations.

Chemotherapy and Radiation Therapy

Chemotherapy and radiation therapy are a major part of most cancer treatment plans. However, they’re not often used to treat melanoma.

Chemotherapy uses toxic chemicals that kill rapidly dividing cells. It may be used to treat metastatic melanoma after trying other treatment options. Chemotherapy can help shrink tumors in some people, but it may not work for everyone. In mid-2023, the FDA approved Hepzato Kit, which delivers the chemotherapy drug melphalan directly to the liver. This is a treatment option for people with uveal melanoma that’s spread to the liver.

Radiation therapy uses concentrated beams of radiation to damage melanoma cells. It may be used:

• To treat early-stage melanoma that can’t be removed with surgery
• As an adjuvant treatment after surgery to lower the risk of melanoma returning
• As a palliative treatment to relieve symptoms from tumor spread to the bones or brain

Clinical Trials

Clinical trials are vital to develop new treatments for melanoma. Participating in cancer research may also give you access to new types of treatments. If you’re interested in learning more about what’s involved in joining a study focused on the treatment of melanoma, talk to your oncologist.

Lifestyle Changes

Your oncologist may also recommend lifestyle changes to improve your overall health and lower the risk of your melanoma returning. Be sure to wear sunscreen and protective clothing to shield yourself from the sun. You should also regularly check your skin for any new signs of melanoma. Your doctor may also encourage you to eat a healthy diet and quit smoking (if you do smoke).

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

What treatments have you had for melanoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.