Choosing the Best Melanoma Treatment for You

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Melanoma is a form of cancer that starts in the melanocytes—cells that make melanin. Melanin is the brown pigment that gives skin color. Melanoma can arise in many different body sites; however, the majority involve the skin. Melanoma is less common that the other major types of skin cancer—basal cell and squamous cell skin cancers. But it is much more aggressive and dangerous. Still, it is highly treatable when caught in the earliest stages. As a result, the tumor stage will help determine which melanoma treatment is best.   

Surgery

Surgery removes the melanoma and some surrounding healthy skin. There are a few techniques for removing melanoma. They include simple excision to cut out thin melanomas and a small amount of healthy skin, wide excision to cut out a larger or deeper melanoma, and Mohs surgery to shave off layers of skin until no cancer cells are present. Skin grafting may be necessary afterwards. Sometimes, doctors must also remove lymph nodes in the area to check for melanoma that has spread.

Surgery is the main treatment for all stages of melanoma. In early stages, surgery has a high likelihood of cure and may be the only treatment necessary. Doctors may still recommend surgery even if melanoma cancer has spread. In this case, surgery can’t cure melanoma, but it may extend life and relieve symptoms.

Immunotherapy

Immunotherapy—or biologic therapy—uses a person’s own immune system to fight cancer. These medicines boost the immune system to help it find and kill cancer cells better. In most cases, immunotherapy comes as an IV (intravenous) medicine. There is also a cream available to treat melanoma.

Doctors most often add immunotherapy to late stage or advanced melanoma treatment. This includes melanoma that is likely to recur or that has already spread. Sometimes, doctors use immunotherapy with surgery in early stages. A doctor may use the cream in place of surgery when melanoma is only in the very outer skin layer. Not all doctors agree with this approach, so a second opinion could be useful. 

Targeted Therapies 

Targeted therapies work differently from standard chemotherapy drugs. They target specific markers that are only present on cancer cells. This often means fewer or less severe side effects and sometimes they work when standard chemotherapy does not. 

Targeted therapies are an exciting advance in melanoma treatment. Scientists have found two specific gene changes related to melanoma. One accounts for nearly half of all melanoma cases. Targeting these gene changes can help treat melanoma when surgery isn’t possible. Doctors will send a sample of tumor tissue to the laboratory to see if it has the gene changes that would make these treatments worth trying.

Radiation

Radiation therapy uses high-energy waves or particles to kill cancer cells. Doctors rarely use radiation as the main treatment for melanoma. It may be useful after surgery to keep cancer from coming back, especially if cancer was present in lymph nodes. Doctors may also use it to treat melanoma that comes back after surgery. In advanced cases, radiation can relieve symptoms of melanoma that has spread.

Chemotherapy

Chemotherapy—or chemo—uses potent medicines to treat cancer. Chemotherapy is not very useful for treating melanoma. In general, doctors only use it to treat advanced melanoma or melanoma that has spread. In these cases, chemotherapy can help relieve symptoms and may extend life. People take chemo drugs in cycles that last for a few weeks.

Making the Decision

Talk with your doctor about the treatment options available for the stage, thickness and location of your melanoma. Many novel treatments are emerging for melanoma. Other considerations include your general health, the rate of melanoma growth, the presence of gene changes within the tumor cells, and whether melanoma has already spread. You may also want to get a second opinion before making a treatment decision. Your doctor should encourage this because it can help you feel more confident about your final decision.
Once you’ve decided on a course of action, think about where you will receive your care. Picking a hospital or treatment center is just as important as choosing the right doctor. Find out whether the best treatment for you is available locally or not. Depending on your circumstances, consider asking about enrollment in a clinical trial. Think about whether you are willing to travel to a center of excellence for melanoma.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 3
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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  5. Melanoma Center of Excellence. Melanoma Hope Network. http://www.melanomahopenetwork.org/Melanoma-Center-of-Excellence/