Stage 0 cancers are the least serious, while stage IV melanomas are hardest to treat.
A second surgery is sometimes needed if cancer cells creep into the edges of the removed section of skin.
If the lesion is on your face, your doctor might recommend a procedure called Mohs surgery. With this, they’ll remove thin layers of skin until they can see where the cancer stops. The goal is to get rid of the cancer but keep as much healthy skin as possible.
Instead of surgery, some doctors suggest radiation therapy or treatment with a topical cream called imiquimod (Aldara, Zyclara). But not all experts agree that these are the right treatments for stage 0 melanoma.
Stages I and II
Melanomas in these stages are also typically treated with wide excision surgery.
If your cancer seems likely to grow quickly or spread, your doctor might recommend a procedure called a sentinel lymph node biopsy. Lymph nodes are tiny bean-shaped structures scattered throughout your body -- they’re part of your immune system. Your surgeon will take out the lymph node that’s most likely to have cancer cells if the disease has spread and send it to a lab for testing.
Stages III and IV
Stage III is when the cancer has spread to your lymph nodes but nowhere else in your body. Stage IV is when it has spread to your lymph nodes as well as other areas.
The first step with either one is usually surgery to take out the tumor and the affected lymph nodes.
Other treatments might include:
- Immunotherapy: This helps your body’s immune system find and destroy cancer cells. These medications include ipilimumab (Yervoy), interleukin-2 (IL-2), interferon therapy, nivolumab (Opdivo), nivolumab-relatlimab-rmbw (Opdualag), pembrolizumab (Keytruda), and imiquimod (Aldara, Zyclara) cream.
- Targeted therapy: These treatments take aim at specific parts of cancer cells. For example, some targeted therapies go after melanoma cells that have changes in certain genes. These include binimetinib (Mektovi), cobimetinib (Cotellic), dabrafenib (Tafinlar), encorafenib (Braftovi), imatinib (Gleevec), nilotinib (Tasigna), trametinib (Mekinist), and vemurafenib (Zelboraf).
- Vaccines: The T-VEC (Imlygic) and Bacille Calmette-Guerin (BCG) vaccines are injected directly into melanoma tumors. They help your immune system work to kill cancer cells. Researchers are testing other vaccines that may keep the cancer from coming back.
- Radiation therapy: This uses beams of energy to destroy cancer cells. It’s usually done on the area where lymph nodes were removed.
- Chemotherapy: This is a combination of powerful drugs used to kill cancer cells. It’s recommended more often with stage III. Chemo is usually only an option for stage IV if other treatments haven’t worked.
- Isolated limb perfusion: When melanoma affects your arm or leg, doctors may inject a heated dose of chemotherapy into it.
These therapies may be used after surgery, alone, or with one another other. For example, doctors sometimes suggest biochemotherapy -- a blend of chemo and either interleukin-2, interferon, or both.
Many people with stage III or IV melanoma look to clinical trials for treatments that aren’t available to the general public. These are research studies that test medications and other therapies before they’re approved for use by everyone.
Melanoma can sometimes come back. If this happens, your treatment options will depend on where the cancer returns, the stage of your disease, and your original treatment, among other things.
Options for recurrent melanoma might include:
- Sentinel lymph node biopsy
- Isolated limb perfusion
- Targeted therapy
Your doctor can help you figure out which is best for your situation.
Keep in mind that some herbal supplements can affect your health or the way some medications work. It’s important to talk to your doctor before trying any type of complementary treatment.