Treatment of Melanoma depends on how far the tumor has grown within the skin, whether the cancer has spread to nearby lymph nodes and whether the cancer has metastasized to distant organs. Based on the stage of melanoma, treatment options may include: surgery, immunotherapy, targeted therapy, chemotherapy, and radiation therapy.
Stage I: in Stage I, melanoma is treated by wide excision where a 1-2 cm incision is made around the original melanoma site. A sentinel lymph node biopsy (following the path of an injected radioactive tracer substance and dye injected into the melanoma) may also be performed to ascertain if the melanoma has spread to the nearest lymph nodes. If the sentinel lymph node biopsy is positive it is usually followed by a lymph node dissection, sometimes with interferon immunology treatment.
Stage II: in Stage II, the standard treatment is a wide excision, sentinel lymph node biopsy (if positive, followed by a lymph node dissection), interferon treatment and/ or vaccines.
Stage III: in Stage III, treatment includes a wide excision surgery and lymph node dissection. Adjuvant therapy with interferon immunotherapy and radiation therapy to the areas where the lymph nodes were removed may be recommended. Immunotherapy treatments to stimulate the immune system may be used which may include the Bacille Calmette-Guerin (BCG) vaccine, interluekin-2, and imiquimod cream. Chemotherapy may be combined with immunotherapy. For melanomas on an arm or leg, isolated limb perfusion may be , using a heated solution of chemotherapy to the limb).
Stage IV: in Stage IV, treatment includes surgery, radiation therapy, immunotherapy, targeted therapy and/or chemotherapy. There are many types of immunotherapy used for advanced melanoma by boosting the immune system to better attack the cancer, such as Ipilimumab (Yervoy) and pembrolizumab (Keytruda), which are both versions of a type of immune system protein (monoclonal antibodies).
Drugs targeting specific gene changes: in about 50% of melanomas, the cancer cells have mutations in the BRAF gene and treatments that target this change may be used, including vemurafenib, dabrafenib, and trametinib.
For melanomas with mutations in the C-KIT gene, imatinib and nilotinib may be prescribed. Chemotherapy, such as dacarbazine or temozolomide, may be used in a biochemotherapy treatment plan using interleukin-2, interferon, or both.