Treatment Overview

Surgical removal (excision) of the affected skin is the most effective treatment for melanoma. Excision involves removing the entire melanoma along with a border (margin) of normal-appearing skin. More treatment may be needed based on the stage of the melanoma.

Initial treatment

Melanoma may be cured if caught and treated in its early stages when it affects only the skin. If melanoma is confined to the skin (primary melanoma), you will have surgery to remove the affected skin. If the melanoma is thin and has not invaded surrounding tissues, excision may cure the melanoma. In more advanced stages, melanoma may spread, or metastasize, to other organs and bones, requiring additional treatment such as radiation, chemotherapy, or immunotherapy.

Treatments used for melanoma include:

• Surgery. Your doctor may use one of these surgeries:
  • Local excision. This surgery takes out the melanoma and a little of the tissue around it.
  • Wide local excision. This surgery removes more of the tissue around the melanoma. Lymph nodes may also be removed during this surgery.
  • Lymph node dissection (lymphadenectomy). This is surgery to remove lymph nodes to see if they have cancer cells. Or this may be done to remove lymph nodes that are cancerous.
  • Sentinel lymph node biopsy. This surgery removes the first lymph node that the cancer may have spread to from the tumor. If this lymph node does not have any cancer cells, then you may not need to have more lymph nodes removed.
• Chemotherapy.
• Radiation therapy.
• Immunotherapy.

Side effects of treatment

The side effects of treatment for melanoma will depend on the type of treatment you have and your age and overall health. The side effects of surgery, chemotherapy, or radiation may be mild enough that you can do things at home to manage them. See the Home Treatment section of this topic for more information.

Some of the treatment side effects can be avoided. For example, your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. Be sure to talk to your doctor about all the side effects that you have.

Ongoing treatment

Regular follow-up appointments are important after you have been diagnosed with melanoma. Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.

Learn to do a skin self-exam and to check for swelling in your lymph nodes, and report any changes to your doctor. It's a good idea to get in the habit of doing this skin and lymph-node check at the same time every month.

Treatment if the condition gets worse

Metastatic melanoma

Swollen or tender lymph nodes may be a sign that the melanoma has spread (metastatic melanoma). Any enlarged regional lymph nodes should be removed and checked for melanoma.

When melanoma has spread to only one tumor in another location, metastatic melanoma sometimes can be successfully treated with surgery. But metastatic melanoma usually responds poorly to most forms of treatment.

When successful treatment is not possible, the goal of treatment for metastatic melanoma is to control symptoms, reduce complications, and increase comfort (palliative care).

Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials study other treatments, such as combinations of chemotherapy, vaccines, and immunotherapies. They are also studying targeted therapy with agents such as PLX4032 and ipilimumab.

Recurrent melanoma

Melanoma can come back after treatment. This called recurrent melanoma. This kind of melanoma, like metastatic melanoma, usually cannot be cured with treatment. But your medical team will keep you comfortable and help you live as long as possible. Treatments that may help include:

• Surgery to remove any tumors.
• Hyperthermic isolated limb perfusion. If the melanoma is on your arm or leg, chemotherapy medicine may be added to a warm solution and injected into the bloodstream of that limb. The flow of blood to and from that limb is stopped for a short time so the medicine can go right to the tumor.
• Radiation or immunotherapy to relieve symptoms (palliative therapy).
• Medicines injected directly into tumors.
• Lasers to destroy tumors.

Palliative care may be an important part of your treatment plan.

What To Think About

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It is normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with their family and friends.

If your emotional reaction to cancer interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group.

Palliative care

Cancer treatment has two main goals: to cure the cancer and to make your quality of life as good as possible. Your quality of life may be improved by having palliative care to manage your symptoms.

For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:

Palliative Care.

Hospice Care.

Care at the End of Life.

For more information about specific treatments, see the following topics:

• Melanoma Treatment (PDQ): Health Professional Information
• Melanoma Treatment (PDQ): Patient Information