HEALTH CONDITION

Treatment

Surgery is the main treatment for melanoma.

If you have melanoma skin cancer you'll be cared for by a team of specialists that should include a skin specialist (dermatologist), a plastic surgeon, a specialist in radiotherapy and chemotherapy (oncologist), an expert in tissue diseases (pathologist) and a specialist nurse.

When helping you decide on your treatment, the team will consider:

  • the type of cancer you have
  • the stage of the cancer (its size and how far it has spread)
  • your general health

Your treatment team will recommend what they believe to be the best treatment option, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist.

For example, you may want to find out about the advantages and disadvantages of particular treatments.

Read more about questions to ask your doctor.

Treating stage 1 melanoma involves surgery to remove the melanoma and a small area of skin around it. This is known as surgical excision.

Surgical excision is usually done using local anaesthetic, which means you'll be awake, but the area around the melanoma will be numbed, so you will not feel pain. In some cases, general anaesthetic is used, which means you'll be unconscious during the procedure.

If a surgical excision is likely to leave a significant scar, it may be done in combination with a skin graft. However, skin flaps are now more commonly used because the scars are usually less noticeable than those resulting from a skin graft.

Read more about flap surgery.

In most cases, once the melanoma has been removed there's little possibility of it returning and no further treatment should be needed. Most people (80 to 90%) are monitored for 1 to 5 years and are then discharged with no further problems.

Sentinel lymph node biopsy

A sentinel lymph node biopsy is a procedure to test for the spread of cancer.

It may be offered to people with stage 1B to 2C melanoma. It's done at the same time as surgical excision.

You'll decide with your doctor whether to have a sentinel lymph node biopsy.

If you decide to have the procedure and the results show no spread to nearby lymph nodes, it's unlikely you'll have further problems with this melanoma.

If the results confirm melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required.

Additional surgery involves removing the remaining nodes, which is known as a lymph node dissection or completion lymphadenectomy.

If the melanoma has spread to nearby lymph nodes (stage 3 melanoma), further surgery may be needed to remove them.

Stage 3 melanoma may be diagnosed by a sentinel node biopsy, or you or a member of your treatment team may have felt a lump in your lymph nodes.

The diagnosis of melanoma is usually confirmed using a needle biopsy (fine needle aspiration).

Removing the affected lymph nodes is done under general anaesthetic.

The procedure, called a lymph node dissection, can disrupt the lymphatic system, leading to a build-up of fluids in your limbs. This is known as lymphoedema.

Cancer Research UK has more information about surgery to remove lymph nodes.

If melanoma comes back or spreads to other organs it's called stage 4 melanoma.

In the past, cure from stage 4 melanoma was very rare but new treatments, such as immunotherapy and targeted treatments, show encouraging results.

Treatment for stage 4 melanoma is given in the hope that it can slow the cancer's growth, reduce symptoms, and extend life expectancy.

You may be offered surgery to remove other melanomas that have grown away from the original site. You may also be able to have other treatments to help with your symptoms, such as radiotherapy and medicine.

If you have advanced melanoma, you may decide not to have treatment if it's unlikely to significantly extend your life expectancy, or if you do not have symptoms that cause pain or discomfort.

It's entirely your decision and your treatment team will respect it. If you decide not to receive treatment, pain relief and nursing care will be made available when you need it. This is called palliative care.

Immunotherapy is used to treat advanced (stage 4) melanoma, and it's sometimes offered to people with stage 3 melanoma as part of a clinical trial.

Immunotherapy uses medicine to help the body's immune system find and kill melanoma cells.

Several different medicines are available, some of which can be used on their own (monotherapy) or together (combination therapy).

Medicines used include:

  • ipilimumab
  • nivolumab
  • pembrolizumab
  • talimogene laherparepvec

These medicines are often recommended for people with previously treated or untreated advanced melanoma that's spread or cannot be removed using surgery.

They are given either via a drip or by injection every few weeks. Some medicines are given on a short-term basis over a few weeks. Others are given on a longer-term basis.

Side effects of immunotherapy medicines include:

Around 1 in 2 people with melanoma have a change (mutation) in a gene called BRAF. This mutation causes cells to grow and divide too quickly .

Targeted medicine can be used to target this mutation to slow or stop cancer cells growing.

Targeted treatments for melanoma include:

  • vemurafenib
  • dabrafenib
  • trametinib

These medicines may be recommended as a treatment for people who have the gene mutation and have an aggressive type of melanoma in 1 part of their body or melanoma that's spread.

The side effects of these medicines can include:

Cancer Research UK has more information on immunotherapy and targeted treatments for melanoma.

You may have radiotherapy after an operation to remove your lymph nodes, and it can also be used to help relieve the symptoms of advanced melanoma. Controlled doses of radiation are used to kill the cancerous cells.

If you have advanced melanoma, you may have a single treatment or a few treatments. Radiotherapy after surgery usually consists of a course of 5 treatments a week (1 each day from Monday to Friday) for several weeks. There's a rest period over the weekend.

Common side effects associated with radiotherapy include:

  • tiredness
  • feeling sick
  • loss of appetite
  • hair loss
  • sore skin

Many side effects can be prevented or controlled with prescription medicines, so tell your treatment team if you experience any. The side effects of radiotherapy should gradually reduce once treatment has finished.

Chemotherapy is now rarely used to treat melanoma. Targeted treatments and immunotherapy are the preferred treatment options.

Research is under way to produce vaccines for melanoma, either to treat advanced melanoma or to be used after surgery in people with a high risk of the melanoma returning.

They're currently only given as part of a clinical trial.

Cancer Research UK has more information about melanoma vaccines.

After your treatment, you'll have regular follow-up appointments to check whether:

  • there are signs of the melanoma coming back
  • the melanoma has spread to your lymph nodes or other areas of your body
  • there are signs of any new primary melanomas

Your doctor or nurse will examine you. They'll ask about your general health and whether you have any questions or concerns.

You may be offered treatments, such as immunotherapy, to try to prevent the melanoma returning. This is called adjuvant treatment.

There's not much evidence that adjuvant treatment helps prevent melanoma coming back, so it's currently only offered as part of a clinical trial.

There's evidence that checkpoint therapies, which boost the body's immune responses to cancer, may be used in the future if clinical trials provide evidence that they're effective.

Cancer Research UK has more information about follow-up appointments.

Being diagnosed with melanoma can be difficult to deal with. You may feel shocked, upset, numb, frightened, uncertain and confused. These types of feelings are natural.

You can ask your treatment team about anything you're unsure about.

Your family and friends can be a great source of support. Talking about cancer and how you're feeling can help both you and members of your family cope with the situation.

Some people prefer to talk to people outside their family. There are several UK-based charities that have specially trained staff you can speak to on a free helpline:

Cancer Research UK also has a section about living with melanoma.

Find more cancer support services near you.

Any new cancer treatment is first given to patients in a clinical trial.

A clinical trial is a rigorous way of testing new treatments on people. Patients are closely monitored for any effects the medicine has on the cancer as well as any side effects.

Many people with melanoma are offered entry into clinical trials.

If you're asked to take part in a clinical trial, you'll be given an information sheet, and if you decide to take part you'll be asked to sign a consent form.

You can withdraw from a clinical trial at any time without it affecting your care.


Page last reviewed: Tue Feb 2023 Next review due: Wed Feb 2020

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