Melanoma Treatment
Melanoma is an aggressive skin cancer that begins in melanocytes, the pigment-producing cells that give the skin its color. It commonly develops on sun-exposed areas of the body, such as the face, back, arms and legs, but it can also arise in less visible sites, including the soles of the feet and under the nails. Risk factors include excessive ultraviolet (UV) exposure, fair skin, a history of severe sunburns, numerous or atypical moles and a family history of melanoma.
While skin cancer can affect people of all ages, melanoma is most frequently found in adults older than 50. Warning signs include a new mole or a change in an existing mole, such as asymmetry, irregular borders, multiple colors and rapid growth. Typically, the diagnosis begins with a physical examination and is confirmed through a biopsy of the suspicious skin lesion.
Treatment options for melanoma may include:
Surgery for melanoma
Surgery is the main treatment for melanoma, especially when the cancer is diagnosed at an early stage. The goal is to remove the entire tumor along with a margin of surrounding healthy tissue. The excised tissue will be sent to a laboratory for microscopic examination by a pathologist, who can identify cancerous cells. If the pathologist finds evidence of cancer in the margin, further treatment may be necessary.
What does surgery for melanoma involve?
After assessing the size, depth, location and extent of the tumor, the surgeon will plan the surgery. The standard procedure is a wide local excision, which may be performed under local or general anesthesia. The surgeon will determine the appropriate margin width based on the thickness of the melanoma. If the lesion is superficial, a narrow margin may be sufficient, but if the tumor is deep, a wider margin may be necessary to reduce the risk of cancer recurrence.
If there is concern that melanoma may have spread to nearby lymph nodes, surgical treatment may include a sentinel lymph node biopsy. This procedure aims to identify the first few lymph nodes most likely to contain cancer cells. If melanoma is found in the sentinel nodes, the surgeon may recommend a follow-up procedure to remove additional lymph nodes (lymph node dissection). Though uncommon, surgical treatment for melanoma may also involve removing cancer that has spread to other tissues or organs.
What are the potential benefits of surgery for melanoma?
For melanoma, surgery provides the best opportunity for cure, particularly when the cancer is detected early. Removing the tumor before it spreads can greatly improve the likelihood of long-term treatment success. In more advanced cases, surgery can still play an important role in controlling the cancer, relieving the symptoms and enhancing the patient’s quality of life. If nearby lymph nodes are affected, removing them can further lower the risk of melanoma spread.
What are the possible side effects of surgery for melanoma?
The side effects of melanoma surgery can vary depending on the size, depth, location and extent of the tumor. In general, the patient may experience some pain, swelling, bruising and scarring at the surgical site. If nearby lymph nodes were removed, there is also a risk of swelling due to fluid buildup (lymphedema). Infection and delayed wound healing are also possible, but these risks can usually be managed with proper postoperative care.
What is the recovery process like?
Most patients recover from melanoma surgery without significant complications, although the recovery timeline can vary based on the extent of the procedure. A minor excision may require only a few days of healing, but a more complex surgery involving lymph node removal will likely take more time. During recovery, the patient should limit physical activity and follow the wound care instructions provided by the surgeon. Regular follow-up visits will be scheduled to monitor healing and check for any signs of cancer recurrence.
Florida's Cancer Center of Excellence
Moffitt is a Cancer Center of Excellence by the state of Florida. The designation recognizes providers that exceed service standards and excel in providing quality, comprehensive and patient-coordinated care.
Immunotherapy for melanoma
Immunotherapy is an innovative treatment that harnesses the natural ability of the body’s immune system. Unlike treatments that directly target cancer cells, immunotherapy works by training the immune system to identify and destroy them, offering the potential for a durable response—even in a patient who has not responded to other therapies.
For advanced or metastatic melanoma, immunotherapy may be used as a primary treatment if surgery is not an option. In other cases, it may be given after surgery to lower the risk of cancer recurrence.
What does immunotherapy for melanoma involve?
Immunotherapy for melanoma often involves the use of immune checkpoint inhibitors, such as PD-1 or CTLA-4 inhibitors, which are administered through intravenous (IV) infusion. These drugs work by blocking proteins that normally prevent immune cells from recognizing and attacking melanoma cells. The treatment schedule can vary depending on the specific medication prescribed, but infusions are generally given once every few weeks. In certain cases, checkpoint immunotherapy may be combined with targeted therapy or radiation therapy for heightened treatment effectiveness.
Another emerging immunotherapy for melanoma is tumor-infiltrating lymphocyte (TIL) therapy, which may be considered in an advanced or treatment-resistant case. The process begins with the surgical removal of a portion of the tumor. The excised tissue will be sent to a lab, where a specialist will isolate the immune cells (lymphocytes) that have already entered the tumor in an attempt to fight the cancer. Those lymphocytes will then be multiplied to obtain a large supply. After a short course of immunosuppressive therapy, the patient will receive the expanded lymphocytes via IV infusion, possibly along with IL-2, a growth factor for T-cells that can promote their proliferation.
The goal of TIL therapy is to generate a strong, highly targeted immune response to the melanoma. Early clinical trials have shown encouraging results, particularly in patients who did not respond to other immunotherapies.
What are the potential benefits of immunotherapy for melanoma?
The primary advantage of immunotherapy is its ability to strengthen the body’s natural defenses against melanoma, which may result in long-lasting remission. For a patient with advanced or metastatic cancer, immunotherapy can significantly improve the outcome and quality of life while lowering the risk of recurrence.
What are the possible side effects of immunotherapy for melanoma?
Side effects of immunotherapy can develop during or after treatment as a result of increased immune activity, which can also affect healthy tissues. Common reactions include diarrhea, fatigue, flu-like symptoms and skin rash. Though rare, immunotherapy may also cause inflammation and more serious immune-related complications involving the endocrine glands, intestines, liver or lungs. Throughout treatment and recovery, the patient will be closely monitored so that any adverse effects can be detected early and managed appropriately.
What is the recovery process like?
Recovery during and after immunotherapy can vary depending on the type of treatment received and the patient’s response and overall health. Some patients experience minimal side effects and can return to their regular activities quickly, while others may need additional time to recover from fatigue or immune-related side effects. Ongoing follow-up care will be important to monitor for signs of cancer recurrence, manage any long-term effects and ensure the immune system continues to function properly.
Ranked a Top Cancer Hospital in Nation
Moffitt is ranked 15th in the nation and is the top-ranked cancer hospital in Florida and the Southeast in Newsweek’s “America’s Best Cancer Hospitals."
Targeted therapy for melanoma
Targeted therapy works by focusing on the specific genetic mutations or proteins that drive the growth and survival of cancer cells. For melanoma, this treatment approach may be considered if an advanced tumor carries a BRAF gene mutation, which is present in approximately half of all cases. By blocking cancer-related signaling pathways, targeted therapy can slow melanoma progression and shrink the tumor with greater precision than traditional chemotherapy.
What does targeted therapy for melanoma involve?
Before targeted therapy is initiated, the melanoma tumor will be tested for specific genetic mutations, such as BRAF V600E and V600K. If a qualifying mutation is identified, treatment may involve a combination of BRAF inhibitors and MEK inhibitors, which will work together to block abnormal cell signaling and slow tumor growth. These medications are typically taken orally on a daily schedule and may be administered continuously or in cycles, depending on the patient’s overall health and response to therapy.
What are the potential benefits of targeted therapy for melanoma?
Targeted therapy is a highly personalized treatment approach for melanoma tumors that carry specific genetic mutations, increasing the likelihood of a meaningful response. Compared to traditional chemotherapy, targeted therapy may provide faster tumor shrinkage and longer-lasting cancer control. When used appropriately, it can improve the outcome and avoid or delay the need for more aggressive treatment.
What are the possible side effects of targeted therapy for melanoma?
Although targeted therapy is generally better tolerated than chemotherapy, it can still cause adverse effects. Common reactions include fatigue, fever, gastrointestinal upset, joint pain and skin rash. Some patients may also experience more serious side effects, such as changes in liver function, heightened skin sensitivity and heart-related complications. These risks can be carefully managed through regular clinical monitoring and periodic blood tests.
What is the recovery process like?
Because targeted therapy is usually taken orally at home, there is no formal recovery period similar to that required after surgery or inpatient treatment. Even so, the patient may still need some time to adjust to any side effects and establish a consistent medication routine. Ongoing follow-up care will be essential to monitor the treatment response, manage any symptoms and adjust the plan as needed. With proper support, most patients can continue their daily activities while undergoing targeted therapy.
ACR Accredited Radiation Oncology Facility
The American College of Radiology gold seal accreditation recognizes Moffitt’s high level of image quality and safety, and the department’s excellence in the areas of equipment, medical personnel and quality assurance.
Radiation therapy for melanoma
Radiation therapy uses high-energy beams to destroy cancer cells or slow their growth. While it is not usually the primary treatment for melanoma, it may be considered if surgery is not an option or the cancer has spread to the brain or bones. Radiation treatment can also be used after surgery to reduce the risk of recurrence.
What does radiation therapy for melanoma involve?
The most common type of radiation treatment for melanoma is external beam radiation therapy (EBRT), which uses an external machine (linear accelerator) to direct precise doses of radiation to the tumor site. Treatments are generally scheduled five days per week for several weeks, depending on the size and location of the tumor. Advanced imaging and planning techniques are often employed to minimize exposure to the surrounding healthy tissues. In certain cases—particularly those involving brain metastasis—stereotactic radiosurgery (SRS) may be used to deliver higher doses of radiation in fewer sessions.
What are the potential benefits of radiation therapy for melanoma?
Radiation therapy can help control melanoma progression in areas of the body where surgery is not feasible or would cause significant functional or cosmetic concerns. Additionally, it may be used to reduce the risk of local recurrence after tumor removal. Radiation therapy can also be highly effective for treating symptoms related to metastasis, such as pain and neurological issues. When used as part of a comprehensive melanoma treatment plan, it can improve both local tumor control and the patient’s overall quality of life.
What are the possible side effects of radiation therapy for melanoma?
The side effects of radiation therapy can vary based on the area of the body treated. In general, common concerns include fatigue, hair loss and skin irritation at the treatment site. Additionally, if radiation therapy is delivered to the head or neck, it may cause changes in taste, difficulty swallowing or dry mouth. Most of these adverse effects are manageable and resolve after treatment ends.
What is the recovery process like?
Recovery after radiation therapy is usually gradual. Many patients experience fatigue during treatment, which may persist for several weeks afterward. The skin in the treated area may also need time to heal and should be cared for according to the physician’s instructions. During follow-up visits, the medical team will monitor the patient’s recovery, assess the response to treatment and address any lingering side effects. Depending on the intensity of the therapy, most patients can maintain their daily routine during treatment or return to it shortly afterward.
Chemotherapy for melanoma
Chemotherapy uses potent medications to destroy cancerous cells or inhibit their growth. While it was once a standard treatment for advanced melanoma, its role has diminished with the advent of newer—and potentially more effective—therapies, such as immunotherapy and targeted therapy. Nonetheless, chemotherapy may still be appropriate in certain clinical scenarios, such as when other treatments are unavailable or ineffective, or when widespread melanoma requires rapid control.
What does chemotherapy for melanoma involve?
Chemotherapy for melanoma is usually administered intravenously. Common drugs include dacarbazine and temozolomide. This systemic treatment is often given in cycles, with each period of active therapy followed by a rest period to allow the body time to recover.
What are the potential benefits of chemotherapy for melanoma?
Chemotherapy can help shrink tumors, relieve symptoms and slow the progression of advanced melanoma. For a patient who is not a candidate for newer therapies or does not respond to them, chemotherapy may improve quality of life and provide temporary cancer control, particularly for rapidly growing or symptomatic tumors.
What are the possible side effects of chemotherapy for melanoma?
Like many cancer treatments, chemotherapy can lead to a range of side effects. During treatment, some patients experience fatigue, hair loss, nausea or vomiting, increased risk of infection or loss of appetite. The type and severity of any adverse reactions can vary depending on the medications used, the dosage and the patient’s overall health. In most cases, the side effects are temporary and can be managed with appropriate supportive care.
What is the recovery process like?
Recovery from chemotherapy focuses on managing any side effects and monitoring the patient’s progress. Many patients need time to regain their strength and energy, particularly after multiple treatment cycles. During regular follow-up visits, the oncology team will evaluate the response to treatment and guide any further care. While most patients can gradually resume their normal activities, some long-term side effects may require ongoing management.
Intralesional and infusional therapies for metastatic melanoma
Intralesional and infusional therapies are specialized treatments that may be used in select cases of metastatic melanoma, particularly when the tumor is confined to a specific area of the body but cannot be surgically removed. These therapies are designed to deliver treatment directly to the tumor and affected tissues, offering a localized or regional alternative to systemic therapy, such as chemotherapy. This targeted treatment approach may be considered for a patient with in-transit melanoma lesions, locoregionally advanced cancer or liver-dominant metastases, especially when other therapies are ineffective.
What do intralesional and infusional therapies for metastatic melanoma involve?
Intralesional therapies involve injecting a therapeutic agent directly into a tumor. For melanoma treatment, one commonly used agent is talimogene laherparepvec (T-VEC), an FDA-approved oncolytic virus that can stimulate an immune response and destroy cancerous cells. Other agents currently under investigation include certain viral therapies and immune-stimulating compounds.
Infusional therapies, such as isolated limb infusion (ILI) and percutaneous hepatic perfusion (PHP), involve delivering high-dose chemotherapy to a targeted area of the body while limiting exposure to other tissues. ILI uses a special tourniquet to confine the chemotherapy to a limb affected by multiple unresectable melanoma lesions. PHP isolates the liver’s circulation and infuses high-dose chemotherapy directly into the organ, making it particularly effective for liver-dominant cancer, such as metastatic uveal melanoma.
What are the potential benefits of intralesional and infusional therapies for metastatic melanoma?
The key benefit of intralesional and infusional therapies is the ability to deliver concentrated treatment directly to a cancer site while minimizing any systemic side effects. This targeted approach may improve tumor control in a patient who has not responded well to standard therapies. For example, a patient with multiple in-transit limb lesions or liver-predominant metastases may experience improved local control, symptom relief and possibly a durable response. These therapies also offer the potential for integration with systemic treatments, which may further enhance the patient’s outcome and quality of life.
What are the possible side effects of intralesional and infusional therapies for metastatic melanoma?
Side effects of intralesional and infusion therapies can vary depending on the specific therapy used and the area of the body treated. Intralesional therapies, such as T-VEC, may cause localized swelling, redness or flu-like symptoms. Infusional therapies can lead to regional discomfort, temporary tissue damage or complications related to catheter placement. ILI may cause localized pain or inflammation in the treated limb, while PHP can result in liver-related side effects or vascular complications. In general, these treatments are designed to limit systemic toxicity, and the patient will be closely monitored for any adverse effects.
What is the recovery process like?
Recovery after intralesional or infusional therapy can vary depending on the extent of the treatment and the patient’s overall health. Intralesional injections are typically performed in an outpatient setting and involve minimal downtime. Recovery from infusional therapies, such as ILI and PHP, may take longer and could require observation in a hospital setting, especially in the days immediately following treatment. The patient will be monitored for side effects and treatment response, with follow-up imaging and clinical evaluations used to determine the next steps. Most individuals can gradually resume their daily activities as their recovery progresses.
Benefit from world-class care at Moffitt Cancer Center
If you would like to learn more about melanoma treatment, you can request an appointment with a specialist in the outstanding Cutaneous Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.
Helpful Links:
