What are the treatment options for melanoma?

Skin cancer can often be completely removed through surgery, so it is usually the treatment of first choice. In surgery, the doctor not only removes the tumor itself, but also some of the tissue around it. This is done to prevent any cancer cells from staying behind and spreading inside the body. Before the surgery, the affected area of skin is numbed using a local anesthetic.

Smaller wounds often heal without scarring, but bigger operations can leave visible scars. Sometimes a second operation is needed as soon as the removed piece of skin has been examined. For instance, the surgeon may have to remove a larger area of tissue around the tumor.

If the melanoma is small and less than 1 millimeter thick, surgically removing just the melanoma is normally enough. If it's larger, a nearby lymph node – known as the sentinel lymph node – is removed too. If no tumor cells are found in the lymph node, it usually means that the melanoma cancer cells haven't spread to other parts of the body. If the sentinel lymph node has tumor cells in it, the lymph nodes around it are removed too.

Radiotherapy, also known as radiation therapy, aims to destroy cancerous tissue using high-energy radiation. It is mainly used to treat melanoma that is already at a very advanced stage, has already led to metastatic tumors or can't be surgically removed.

Medication can be used at different stages of skin cancer. Some are used after surgery to remove larger melanomas, or if the cancer has spread to lymph nodes. The aim is to fight any cancer cells that are still in the body. Other types of medication are only used if there are already several metastatic tumors in the body or if surgery is no longer possible.

The medication options for metastatic melanoma will depend on various factors – for instance, whether medication has already been used and, if so, which medication. Some drugs are only used in combination with another drug, or to treat certain types of melanoma cells.

The medications that can be used to treat melanoma include the following:

• Targeted therapy: This kind of treatment makes use of the fact that the reason why cancer cells grow uncontrollably is often because certain parts of the cells have changed. The therapy is said to be “targeted” because it uses drugs to specifically switch off those parts of the cells. This is only an option for people with tumors that have these kinds of cell changes. Typical examples of medications used for targeted therapy include BRAF inhibitors such as vemurafenib and dabrafenib. These medications are sometimes combined with the drugs cobimetinib or trametinib too.
• Immunotherapy: This involves using substances to stimulate the body’s immune system. More specifically, the substances activate immune system cells that are capable of destroying cancer cells. Interferon-alpha, a chemical messenger in the immune system, is one example. Antibodies can also be used in immunotherapy. These can, for instance, attach to immune system cells and activate them so they kill cancer cells. Examples of these drugs that are approved for the treatment of melanoma include ipilimumab, nivolumab and pembrolizumab.
• Chemotherapy: In chemotherapy, medications known as cytostatic drugs are used with the aim of damaging the cancer cells. The cytostatic drugs used in the treatment of melanoma include dacarbazine, paclitaxel and platinum-based drugs. They are often combined with each other. Cytostatics are usually only used to treat melanoma if all of the other medication options have been exhausted.