Treatment options

Your specialist will be part of a team of health professionals who work together with you to decide on the best treatment for you. This team is called the multidisciplinary team (MDT).

There are 2 levels of MDT for melanoma and other skin cancers. They are the Local Hospital Skin Cancer Multidisciplinary Team (LSMDT) and a Specialist Skin Cancer Multidisciplinary team (SSMDT).

LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer centres, or plastic surgery centres. Everyone with suspected melanoma will see a member of one of these teams.

Your treatment depends on:

• where your cancer is
• how far it has grown or spread (the stage)
• your general health and level of fitness

The depth of the melanoma in the skin affects how likely it is to come back and whether it may spread. The doctors use this information to diagnose what stage melanoma you have.

Treatment overview

Surgery is the main treatment for melanoma that hasn't spread.

If your melanoma has spread treatment might include one or more of the following:

• surgery
• immunotherapy
• targeted cancer drugs
• radiotherapy to specific sites of melanoma, for example the bone or brain
• injecting treatment directly into the melanoma (Intralesional therapy), for example talimogene laherparepvec (T-VEC)
• laser surgery using carbon dioxide laser
• chemotherapy directly into the arm or leg where the melanoma is (isolated limb infusion or isolated limb perfusion)
• chemotherapy combined with an electric current (electrochemotherapy)
• chemotherapy – usually you only have chemotherapy if you’re unable to have a targeted cancer drug or immunotherapy
• take part in a clinical trial

Treatment by stage

Melanoma in situ (stage 0)

Surgery is the main treatment. To diagnose melanoma doctors remove the abnormal area of skin and a small area of surrounding skin. You may then need a second operation to remove a larger area of healthy tissue around where the melanoma was. This is called a wide local excision. As long as the doctors are sure they removed enough tissue, this is all the treatment you need.  

Surgery can cause scarring and some people may not be well enough to have an operation. Instead of surgery, you might have treatment with a cream called imiquimod. You put imiquimod on the affected area, over a period of weeks.

Or your doctor might suggest having regular ultrasound scans of the lymph nodes to check if the cancer grows (progresses). This is called surveillance.

Stage 1 and 2

Stage 1 and 2 melanoma are early cancers. The cancer is only in the skin and hasn’t spread to other parts of the body. Surgery is the main treatment.

After diagnosis, you usually have a second operation to remove a larger area of healthy tissue around where the melanoma was (a wide local excision). 

For most stage 1A melanomas, if your doctors are sure that they removed enough tissue, this is usually all the treatment you need.

Lymph node staging and sentinel lymph node biopsy

For some stage 1A and all stage 1B and stage 2 melanomas, your doctor might offer you a test to check the lymph nodes nearest to the melanoma for cancer cells. The test is called a sentinel lymph node biopsy.

You usually have it while you're asleep (general anaesthetic) at the same time you have your wide local excision.

Some people with melanoma may decide to have ultrasound surveillance of their lymph nodes instead of a sentinel node biopsy. This service may not be available at all hospitals. Ultrasound surveillance is usually for 5 years. You may need a biopsy if there is a concern that melanoma is in your lymph nodes. If melanoma is found your doctor may suggest that you have your lymph node removed. 

For most people with thin melanomas, cancer cells aren’t found in the nearby lymph nodes. But if they are (a positive sentinel lymph node biopsy) your stage of melanoma changes to stage 3.

Stage 3

Stage 3 melanoma skin cancer means that cancer cells have spread to the lymph nodes closest to the melanoma or to an area between the melanoma and the lymph nodes.

After being diagnosed with melanoma you have an operation to remove more tissue in the area where the melanoma was (wide local excision). 

Cancer in the area between the melanoma and the nearby lymph nodes

When melanoma spreads away from the primary tumour towards the nearby lymph nodes they are called satellite or in-transit metastases depending on their distance from your melanoma. Surgery is the main treatment.

If you can’t have surgery, you might have one of the following:

• laser surgery using a carbon dioxide laser
• injecting directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
• chemotherapy combined with an electric current (electrochemotherapy)
• chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
• targeted cancer drugs
• immunotherapy
• chemotherapy
• take part in a clinical trial

Melanoma in the lymph nodes

If you have melanoma cells in the nearby lymph nodes that were picked up from a sentinel lymph node biopsy (microscopic disease) your doctor might suggest:

• regular ultrasound scans
• targeted cancer drugs or immunotherapy

You don’t usually need to have the rest of the lymph nodes removed in this situation.

If you have swollen or abnormal looking lymph nodes and a biopsy confirmed the melanoma has spread there, you usually have surgery to remove the lymph nodes. This is called a completion lymph node dissection or lymphadenectomy.

Treatment after surgery

Your doctor might offer you treatment after surgery. This is called adjuvant treatment. The aim is to reduce the risk of the cancer coming back.

You might have targeted cancer drugs or immunotherapy for a year.

Stage 4

Stage 4 means the cancer has spread to other parts of the body, such as the liver. It is also called advanced melanoma.

You might have one or more of the following treatments to help control the cancer and it's symptoms:

• surgery
• targeted cancer drugs
• immunotherapy
• radiotherapy to specific sites of melanoma spread, for example the bone or brain
• injecting a drug directly into the melanoma (intralesional therapy), for example Talimogene laherparepvec (T-VEC)
• chemotherapy directly into the leg or arm where the melanoma is (known as isolated limb infusion or isolated limb perfusion)
• chemotherapy combined with an electric current (electrochemotherapy)
• chemotherapy – usually you would only have chemotherapy if you’re unable to have a targeted cancer drug or immunotherapy
• take part in a clinical trial

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.