Doctors have a lot of tools that can treat melanoma. Generally, the earlier you and your doctor catch it, the simpler it is to handle. Each person is different, and your team will tailor your care to fit your situation. Your doctor will tell you about all your options. Ask what they recommend for you and why, and about the benefits and side effects of each one. Together, you can choose the plan that will be best for you.
Sometimes it helps to see another doctor. Getting a second opinion can help confirm you've made the right treatment choice.
The treatment you get will depend on a few things:
- How deep the melanoma is in your skin
- Whether it has spread to other parts of your body
- Your general health
Often, the first step is to remove the tumor from your skin, usually with surgery. This works best for melanoma that has spread to only a few places. Removing the tumors won't cure the cancer, but it can relieve pain and help you live longer.
Your doctor or surgeon will numb your skin and cut out the melanoma, plus some extra skin around it. You’ll have stitches for 1-2 weeks. If it isn’t deep, a doctor who treats skin, called a dermatologist, can do the operation during a regular surgery visit, and you can go home right after. This might be all you need, especially if the cancer is only in the top layer of your skin. The surgeon will stitch up the opening. You'll have a scar. If the wound is big, the surgeon can take a piece of skin from another part of your body to cover it. This procedure is called a skin graft.
Your team will check to make sure all the cancer cells came out. If any remain, you may get chemotherapy or other therapy to kill them.
Treatments Below the Surface
If the tumor has grown deep into your skin or spread to other parts of your body, treatment is more complex. You might need surgery to remove lymph nodes near the melanoma to see if the cancer has spread there. For example, if the problem is on your arm, the surgeon might take out the lymph nodes under your armpit. For larger tumors, you might have to stay in the hospital overnight.
Other options are:
Immunotherapy. This approach uses drugs that help your immune system find and attack cancer cells. You might get them in a shot or go to a treatment center or hospital to get them through an IV every 2-4 weeks. If the melanoma is on your face, your doctor might prescribe a cream that revs up the immune cells only around the tumor, instead of in your whole body like the other drugs.
Sometimes, immunotherapy drugs can make your body attack your healthy organs. If that happens, you’ll need to stop taking them and get other treatments to stop the attack.
Chemotherapy. These drugs travel through your body and attack cancer cells. Some chemotherapy drugs are pills, and others you get through an IV. Although chemo won't cure melanoma, it can relieve symptoms and it may help you live longer. It sometimes works better when you also take immunotherapy drugs. If your cancer is only in your arm or leg, you may get chemotherapy in just that limb. Doctors call this treatment "isolated limb perfusion."
You'll get chemotherapy in cycles. Between treatments, you'll have a chance to rest and let your body recover. Each cycle lasts for a few weeks. You may also get other types of treatment, such as radiation, at the same time.
Chemo kills all kinds of fast-dividing cells, not just cancer cells. So it can cause side effects such as:
- Hair loss
- Appetite loss
- Nausea and vomiting
- Greater chance of infection
- Mouth sores
- Bruising or bleeding
These problems should stop once you're done with chemo.
Targeted therapy. Cancer happens when cells grow and divide too fast or don’t die when they should. This can happen because of bad genes inside the cells. In targeted therapy, drugs go after changes in melanoma cells that make them grow out of control. Some target a gene change called "BRAF" that makes melanomas grow. Your doctor may call these drugs "BRAF inhibitors." They shrink tumors and help some people live longer.
Side effects include:
Some people who are treated with these medicines later get another, but less serious type of skin cancer. Your doctor will check your skin for signs of cancer during and after your treatment.
Another type of targeted therapy, called "MEK inhibitors," can thwart melanoma. You may take these as a pill. Side effects include:
Some people take both MEK and BRAF inhibitors.
This treatment tends to stop working well after a while. If that happens, you and your doctor will need to try another approach.
Radiation. A specialist will zap the area with high-energy rays, which kill cancer cells. It’s like getting an X-ray, but the dose is stronger. It also can ease pain from melanoma that has spread to the brain or bones.
One type, called radiosurgery, treats melanoma that has spread to the brain. It aims the radiation right at the tumor to avoid damaging healthy brain cells around it.
After radiation, you might have:
- Red skin, like a sunburn
- Hair loss
- Less appetite
- Weight loss
These side effects should go away once you stop radiation.
Your doctor might recommend more than one treatment at a time, like chemotherapy plus radiation. It depends on whether the cancer has spread and how far it has gone.
Drugs That Work on Your Immune System
These medicines use your body's immune system to kill cancer cells. These drugs, which your doctor may call "immunotherapy," fall into two categories:
Checkpoint inhibitors. These medications help your immune system do a better job of attacking cancer cells. You would get these drugs through a vein once every 2 or 3 weeks. Side effects include:
- Feeling tired
- Less appetite
- Joint pain
In rare cases, these drugs cause the immune system to attack the lungs, liver, kidneys, or other organs. Make sure to tell your doctor if you have any side effects.
Cytokines. These boost the immune system as it fights cancer. They can shrink melanoma. You get these drugs through a vein. Side effects include:
- Fluid buildup in the body
Cytokines aren't used very often today because checkpoint inhibitors are safer and work better.
Some doctors combine chemo with one or more immunotherapy drugs, such as the cytokines known as interferon-alpha and interleukin-2. It can help some people feel better because it may shrink tumors. There's not enough evidence to show that it helps you live longer.
Biochemotherapy can have side effects, including:
- Low blood cell count
These creams are medicines that you put on your skin. Imiquimod (Aldara, Zyclara) is one that treats some types of skin cancer. It helps the immune system attack cancer cells.
The FDA hasn't approved it to treat melanoma, but your doctor might recommend it for early-stage melanomas that have only spread in the top layers of skin. Sometimes it's combined with other immune treatments. Researchers are checking to see if this therapy will help people with stage IV melanoma.
Side effects of imiquimod include:
- Red, swollen skin where you used the cream
- Flu-like symptoms
Scientists are working on finding new treatments for melanoma. But they have to test them and compare how they work to current therapies before they become available for everyone. They do this in research studies called clinical trials. Your doctor might know if you can sign up for one. If you’re accepted, you could get either a regular treatment that’s already available or the one that scientists are testing.
Melanoma treatments might cause other kinds of health problems, including:
- Swelling in your arms or legs, called lymphedema. It happens when your body holds on to fluid because your lymph system is blocked or damaged.
- Feeling tired
- Feeling sick to your stomach
- Constipation or diarrhea
- Anxiety or depression
The side effects you have depend on the stage of your disease, how much treatment you get, how long it takes, and your general health. Some of them can last for a while after you finish treatment. Be sure to tell your doctor if you have any side effects, even if you think they’re no big deal. There are almost always ways to control them so you’ll feel better.
After Your Treatment
Melanoma can come back after treatment. It can show up where it was before, or it can start in other places on your skin or in an organ inside your body like your liver. Your doctor will want to watch you closely for signs that the disease has returned, so it’s important to keep your appointments for checkups.
How often you have to see your doctor depends on what stage your melanoma was in when you were diagnosed. Usually it’s every 6-12 months for disease in the early stages, and every 3-6 months for more advanced ones.