Melanoma Treatment Options

If you’ve recently been diagnosed with melanoma, you probably have a lot of questions. As with any cancer diagnosis, it’s important to get all the facts and make informed decisions that will lead to a successful treatment for melanoma.

“The most important treatment of cancer is always the first,” said Juliana Meyer, MD, an Indianapolis melanoma surgeon with Franciscan Physician Network. “Skin cancer patients need to ensure that they have the most experienced melanoma surgeon and team of clinicians who can accurately diagnosis the stage of melanoma and tailor a treatment plan for you.”

Key Takeaways: Melanoma Treatment Options

• Melanoma is staged 0 through 4 based on depth and spread, and treatment approach depends heavily on which stage it's caught at.
• Surgery is typically the first line of defense, ranging from wide local excision to lymph node removal, including minimally invasive options like videoscopic lymphadenectomy for cases that have spread to groin lymph nodes.
• More advanced melanoma may require radiation, immunotherapy, or newer treatments like Imlygic, which uses genetically modified material injected directly into tumors.
• Early-stage (localized) melanoma has a strong 94% five-year survival rate and is often curable, while later-stage disease is more challenging to treat but still has options, including clinical trials.

How Is Melanoma Treated?

If you’ve been diagnosed with melanoma or another type of skin cancer, your treatment choices depend on the stage of the cancer, the location of the tumor and your overall health.

Melanoma treatment will depend on the stage of the skin cancer. There are five stages of melanoma:

• Stage 0: Melanoma has not grown deeper than the top layer of skin.
• Stage 1: Melanoma is beneath the top layer of skin but is not more than 1 mm deep.
• Stage 2: Melanoma is deeper than 1 mm.
• Stage 3: Melanoma is in the skin and lymph nodes. The primary tumor can vary in size or not be visible, and the cancer has spread to nearby lymph nodes or areas of the skin.
• Stage 4: Melanoma has spread (metastasized) to distant lymph nodes or other organs and areas of the body.

According to the American Cancer Society, early-stage melanomas can often be treated with surgery alone, but more advanced cancers often require other treatments. Sometimes more than one type of treatment is used.

Does Melanoma Require Surgery?  

Your first line of defense against melanoma is almost always surgery, especially in earlier cancer stages. The type of surgery depends on the stage of the melanoma.

Wide local excision surgery for melanoma

Because melanoma is the skin cancer most likely to spread, it’s important for surgeons to remove all affected tissue. With wide local excision surgery, surgeons remove the melanoma growth and a larger portion of surrounding tissue. Wide local excision surgery is an outpatient procedure and may be done under local anesthetic as well.

Lymph node dissection

If melanoma has spread to your lymph nodes, surgeons will perform a lymph node dissection surgery. Affected lymph nodes near the melanoma are removed to prevent further spread.

Videoscopic lymphadenectomy

For regional and distant melanoma spread to lymph nodes in the groin area, a specialized procedure called videoscopic lymphadenectomy is available at Franciscan Health Indianapolis. Videoscopic inguinal lymphadenectomy, or VIL for short, is a minimally invasive surgical technique that removes lymph nodes with a laparoscope.

“For certain melanoma patients, VIL is an effective procedure and offers many benefits over traditional invasive surgical therapy,” said Dr. Meyer. “It reduces the risk of infection and leads to speedier recovery. In most cases, patients only have to stay overnight.”

Plastic surgery

Depending on the location of the melanoma, plastic surgery may be a treatment patients might consider. Our cancer team works together with Franciscan's plastic surgeons to ensure the best cosmetic outcomes.

What Other Ways Can Melanoma Be Treated?

If you have been diagnosed with melanoma, surgery may be part of your skin cancer treatment plan. Other ways your melanoma may be treated include:

Radiation

Radiation therapy is a primary treatment for many stages of melanoma. Our radiation oncology team uses the most advanced technology available, allowing us to treat the melanoma without damaging the tissue around it. This treatment uses a carefully placed beam that damages cancer cells and prevents them from growing and dividing. It’s sometimes used following lymph node dissection surgery or VIL to help prevent recurrence of the skin cancer. It’s also often used late-stage 3 and 4 melanoma to treat distant spread of the disease.

Plaque brachytherapy is a new procedure for patients who have ocular melanoma (melanoma in the eye). This procedure involves placing radioactive seeds into the affected area of the eye. This treatment is relatively painless and more effective at treating the tumor and minimizing eyesight damage, compared with traditional external beam therapy.

Immunotherapy

Immunotherapy is a treatment that allows your body’s immune system to attack cancer cells. Immunotherapy medicines are used to treat metastatic melanoma to shrink tumors and extend your life. Some patients with advanced melanoma may be eligible for immunotherapy treatment. Your physician can provide you with options available to you.

New treatments

Imlygic is a newer treatment offered that uses genetically modified material that is injected into tumors. The material multiplies within the tumor and attacks the tumor cells, destroying them.

Clinical trials

As one of the largest research programs in Indiana, Franciscan Health participates in research studies and clinical trials for caner medications, treatments and procedures specific to melanoma. For people being treated for stage 3 or 4 melanoma, clinical trials may be available to try new therapies to treat your melanoma. Your physician can review available clinical trials and let you know if you’re a candidate for a clinical trial to treat melanoma.

Is Melanoma Curable?

Melanoma is a type of cancer that starts in the pigment-making cells, known as "melanocytes." While not as common as other forms of skin cancer, it is more serious. The stage of your melanoma can determine whether your melanoma is considered curable. 

If your melanoma is considered localized(stages 0-2), the skin cancer hasn’t grown beyond the skin where it started. Most melanoma treatment at this stage is considered curable, and the 5-year survival rate according to the American Cancer Society is 94%.

If you’ve been diagnosed with a regional (stage 3) melanoma that has spread to lymph nodes or other structures, or distant metastatic melanoma (stage 4) that has spread to the lungs, liver, or other parts of the body, it’s more challenging to treat, but options are still available.