Melanoma treatment: what works now and what to ask

Melanoma causes the most deaths among skin cancers, but the good news is treatments have improved a lot in the last decade. If you or someone you love has melanoma, the right next steps depend on the stage and biology of the tumor. This page gives simple, practical info so you can talk confidently with your care team.

How treatments match the stage

Early melanoma is usually cured with surgery. A dermatologist or surgeon removes the tumor with a margin of normal skin. For higher-risk early tumors, doctors often do a sentinel lymph node biopsy to check if cancer spread.

If nodes are involved or the tumor was thick, doctors may recommend adjuvant therapy—treatment after surgery to lower the chance of recurrence. Common adjuvant choices now are immune checkpoint inhibitors (like pembrolizumab or nivolumab) and targeted drug combos when the tumor has a BRAF mutation.

For advanced or metastatic melanoma that has spread beyond lymph nodes, systemic treatments aim to control disease and prolong survival. Two main modern approaches are:

• Immunotherapy: Drugs that boost your immune system to attack melanoma. Checkpoint inhibitors can shrink tumors and sometimes create long-lasting responses.
• Targeted therapy: If genetic testing shows a BRAF mutation, BRAF inhibitors combined with MEK inhibitors can work fast to shrink tumors.

Radiation and older chemotherapy are still used in some cases—typically to control symptoms or treat specific spots, like the brain or bones—often alongside newer systemic drugs.

Practical steps, questions, and follow-up

Ask for clear answers on these points: What is the stage and why? Was the tumor tested for BRAF or other markers? Do I need more surgery or lymph node testing? What are the pros and cons of immunotherapy versus targeted therapy for my case?

Side effects matter. Immunotherapy can cause autoimmune-type problems (skin rashes, gut or liver inflammation). Targeted drugs have different side effects like fever, fatigue, or skin issues. Ask how side effects are monitored and treated so you feel prepared.

Consider clinical trials. Trials often offer access to new drugs or combinations not yet widely available. Your cancer center or oncologist can help you find trials that match your tumor type and condition.

After treatment, regular skin checks and scans are key. Your doctor will set a follow-up schedule based on your stage and treatment. Sun protection, skin exams, and watching for new or changing moles are simple actions you can take every day.

If you want, bring a friend to appointments and write down questions beforehand. Getting a second opinion is reasonable, especially for complex or advanced cases. The right treatment plan combines the tumor’s biology, your health, and your goals for quality of life.