At the OHSU Knight Cancer Institute, we develop an individual treatment plan for each patient.
Your melanoma treatment will differ depending on the depth and how advanced your melanoma is. For more superficial melanomas surgical removal of the tissue may be all that is needed. For melanomas that are deeper or more advanced, additional treatment may be necessary such as testing lymph nodes, chemotherapy, immunotherapy, targeted therapies, radiation or a combination of several treatments. Our multidisciplinary team of dermatologists, surgical and medical oncologists, radiologists and nurses will work together with you to develop a personalized treatment plan.
Depending upon the severity of the disease, your treatment plan for melanoma may include:
- Medical therapy
- Radiation therapy
Many types of early stage melanoma can be treated by removing the skin lesion with a simple in-office excision (removal), more extensive outpatient Mohs surgery, wide local excision (WLE), or inpatient surgery. It is important to eliminate all of the cancerous cells, so some surrounding normal cells may also be removed. In many cases of early stage melanoma, this is all the treatment you will need.
You may need to have some lymph nodes surgically removed if your doctor is concerned about your melanoma spreading (metastatic melanoma).
If your melanoma is advanced, you may need additional therapy in addition to surgery. This is called adjuvant therapy. Treatments intended to attack cancer cells in areas beyond the initial site are called systemic therapies. There have been significant advances in this area for melanoma in the past five years.
Generally, there are two main categories of systemic therapy used to treat melanoma – targeted therapeutics and immunotherapeutics.
About half of people with melanoma have mutations in their tumors in a gene called BRAF. These changes cause the BRAF gene to make an abnormal protein that makes melanoma cells grow rapidly. Medications such as vemurafenib and dabrafenib are BRAF inhibitors, which mean they target and inactivate the abnormal BRAF proteins. MEK inhibitors, such as trametinib, are another type of medication used in conjunction with BRAF inhibitors to treat metastatic melanoma. Both BRAF and MEK inhibitors are taken as pills.
This is an emerging area of therapeutics. Immunotherapy medications act by helping your own immune system to recognize and destroy cancer cells. Examples of these medications include high-dose interleukin 2 (IL-2), ipilimumab, pembrolizumab and nivolumab. These medications are given intravenously.
Radiation therapy uses high-energy rays (such as X-rays) or particles to kill cancer cells.
Sometimes, radiation is used after surgery, especially if the disease has involved the lymph nodes.
Radiation therapy is also used to treat melanoma that has come back (recurred) after surgery and to treat other organs involved by the spread of melanoma.