Melanoma Treatment Options
Surgery is used to treat melanoma that has not spread (metastasized) to other parts of the body. Your surgeon will remove the cancer. They will also remove an area of normal tissue that surrounds it. (This normal tissue is called the margin.) If the surgeon removes a large amount of skin, you may need a skin graft. In this case, your doctor will use skin from another part of your body to replace the skin removed with the melanoma.
Your surgeon may also remove lymph nodes near the tumor. Cancer cells can move to other parts of the body through the lymph nodes. The lymph nodes are sent to a pathologist to look for cancer cells. This will help your doctor know how far the cancer has spread and help determine what the best treatment options are for you.
Sometimes, stage 3 (III) melanoma cannot be fully removed. In this case, the tumor is called “unresectable.” These tumors are treated like stage 4 (IV) melanomas.
Radiation therapy is sometimes considered after surgery. When it is used, the goal is to help keep the cancer from coming back. Your doctor will tell you if radiation is recommended in your case.
Radiation is also often used to treat cancer that spreads (metastasizes) to other parts of the body. It can shrink tumors in the bones or brain that are causing pain or other symptoms.
Systemic therapies move through the bloodstream. They can kill cancer cells throughout the body. These treatments include:
Targeted therapy is a type of cancer treatment that targets a specific change in some cancers that helps them grow, divide, and spread. Targeted drugs are designed to block cancer growth ‘driven’ by these changes. The targeted therapies used to treat melanoma are:
- Braftovi® (encorafenib) and Mektovi® (binimetinib): Bravtovi is a BRAF inhibitor. It is used to treat melanomas with certain mutations (errors) in the BRAF gene. Mektovi is an MEK inhibitor. It targets a protein called MEK. The combination is used to treat patients who have unresectable stage 3 (III) or stage IV melanoma that has a BRAF mutation.
- Cotellic® (cobimetinib) and Zelboraf® (vemurafenib): Cotellic is a MEK inhibitor. Zelboraf is a BRAF inhibitor. They are used together to treat patients with unresectable stage 3 (III) or stage IV melanoma with certain BRAF mutations. Both drugs are pills taken by mouth.
- Mekinist® (trametinib) and Tafinlar® (dabrafenib): Mekinist is a MEK inhibitor. Tafinlar is a BRAF inhibitor. They are used to treat patients with stage 3 (III) melanoma with positive lymph nodes or stage 4 (IV) melanoma with certain BRAF mutations. Both are pills taken by mouth.
These treatments are used in patients where a specific BRAF mutation is found in their cancer, which occurs about half of the time. In most cases, the drugs listed above are used in combination, where patients take both drugs at the same time (e.g. dabrafenib and trametinib). There may be certain cases where a patient is recommended to take only one of the drugs instead of both.
Chemotherapy is the most well-known systemic therapy. It is not often used to treat melanoma. But it is used sometimes after other treatments have been tried first.
Side Effects of Treatment
All cancer treatments have side effects. Before you start treatment, ask your health care team:
- What side effects might I have?
- What should I do if I have these side effects?
- Is there a way to prevent them?
- When should I go to a hospital emergency room?
Radiation therapy: The most common side effects are:
Targeted Therapy: Side effects depend on the drug or drugs you are given. The most common side effects are:
- flu-like symptoms (chills, fever, headache, nausea, cough, loss of appetite)
- a skin rash