Melanoma treatment therapies may include surgery, radiation therapy and immunotherapy. Tests to check for cancer that has spread are also often done.

A biopsy is used to determine the stage of melanoma, which helps doctors decide on a treatment plan. For example, a doctor might recommend wide excision (surgery to remove the melanoma and a margin of healthy skin around it).

Radiation therapy uses high-energy X-rays to destroy cancer cells or prevent them from growing.

Surgical Excision

During surgery, your doctor removes the tumor and a small amount of tissue around it. The tissue is examined under a microscope for cancer cells. If the melanoma is in the skin, you may be able to have it removed with local anesthesia (numbing medicine). If the tumor is deeper under the skin or has spread beyond your skin to nearby lymph nodes, you may need general anesthesia or a skin graft.

Chemotherapy drugs may be given after surgery to kill any cancer cells that are left or to prevent them from coming back (called recurrence). This treatment is called adjuvant therapy.

Immunotherapy medicines can help your immune system recognize and attack cancerous melanoma cells. These medicines include ipilimumab (Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda). Another immunotherapy is talimogene laherparepvec (T-VEC; Imlygic). This is a herpes virus that has been modified in the lab to make it infect and destroy melanoma cells. Clinical trials show that this therapy can shrink melanoma in 10% to 15% of people with unresectable or metastatic melanoma.

Radiation Therapy

Doctors use radiation to kill any remaining melanoma cells and reduce the risk of the tumor coming back (recurrence). Radiation may also relieve symptoms caused by a large or deep melanoma.

Two monoclonal antibodies that block a protein called PD-1 and another protein called PD-L1 have been approved by the FDA to treat stage II, III, or IV melanoma: nivolumab (Opdivo) and pembrolizumab (Keytruda). These drugs stimulate your immune system to attack your melanoma and can improve how long you live.

Sometimes doctors use a herpes virus to treat unresectable melanoma that has spread, such as the immunotherapy drug talimogene laherparepvec (T-VEC; Imlygic). A lab-made version of herpes, this therapy infects and destroys melanoma cells but does not harm noncancerous cells. It is also used in combination with nivolumab and pembrolizumab. Other options include ipilimumab (Yervoy), which stimulates your immune system to fight your melanoma, and interleukin-2, which helps activate T cells. Ask your doctor about clinical trials that offer these drugs or other types of immunotherapy for melanoma.

Chemotherapy

Medications are used to treat cancer by stopping or slowing tumor growth, shrinking the size of tumors and killing any remaining tumor cells. Chemotherapy is sometimes paired with radiation therapy, particularly when the melanoma is in or near critical organs like the brain, bones, lungs and heart.

For metastatic melanoma, systemic therapy can be helpful alone or in combination with surgery. It may also be used to help relieve symptoms or decrease the number of tumors when there are too many for surgery.

Radiation therapy uses beams of high-energy x-rays to kill or prevent the growth of melanoma cells. UT Southwestern offers both traditional radiation therapy and stereotactic radiosurgery, which delivers focused beams of radiation to just 1 or a few areas of the body using a linear accelerator, Gamma Knife or CyberKnife device.

Immunotherapy helps the body's disease-fighting immune cells recognize and attack melanoma. UT Southwestern offers immunotherapy options including interleukin-2 (IL-2), which boosts immune cells, and immune checkpoint inhibitors like ipilimumab or nivolumab and pembrolizumab, which block proteins that stop immune cells from attacking cancerous ones.

Immunotherapy

Immunotherapy is state-of-the-art treatment that stimulates your body’s natural disease-fighting immune system to target and kill melanoma cells. This therapy includes immunomodulators that control how your immune system reacts to cancer and cytokine inhibitors that inhibit specific cytokines, such as interleukins, that promote tumor growth.

Immune checkpoint inhibitors, like ipilimumab (Yervoy) and pembrolizumab (Keytruda), target molecules on immune cells called T cells that suppress the cell’s ability to destroy cancerous cells. UT Southwestern physicians also offer BRAF/MEK inhibitors, such as vemurafenib (Brand name: Veetib), dabrafenib (Tafinab), and trametinib, that block signals passed between molecules within cells to prevent the mutant BRAF gene from functioning.

Some patients with advanced melanoma have a type of immunotherapy known as oncolytic virus therapy. Our doctors use a modified herpes simplex virus called Talimogene laherparepvec (Imlygic) or T-VEC, to kill melanoma by injecting it directly into 1 or more tumors. This is a treatment option for people who cannot or choose not to receive other recommended treatments.