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 therapies block genetic errors (mutations) in cancer cells. 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 50% of the time. In most cases, the medications listed above are used as pairs, where patients take both medications 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 medications instead of both.
Immunotherapy uses a person’s own immune system to recognize and attack cancer cells. Three checkpoint inhibitors (drugs that target and block specific proteins in the body that normally work to suppress the immune system) are used for melanoma. These drugs are ipilimumab (Yervoy®), pembrolizumab (Keytruda®), and nivolumab (Opdivo®). One drug that boosts a person’s immune system in general and is sometimes used for melanoma is aldesleukin (Proleukin®). This cytokine enhances the body’s T-cells to recognize and destroy cancer cells.
Chemotherapy is the most well-known systemic therapy. It is not commonly used to treat melanoma but is sometimes considered after other treatments are used.
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:
- red or dry skin
- hair loss
- feeling very tired.
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