Melanoma Treatment

New advances in the past decade have transformed melanoma treatment, allowing more patients with melanoma to live longer than ever before.

Choosing the correct treatment early on in your diagnosis can determine the success of your cancer journey. Your melanoma treatment plan depends on several factors, including:

• The location of the melanoma
• The stage of the disease and whether it has spread to other parts of your body
• Previous treatments for melanoma
• Your age and overall health
• Your personal preferences

At the University of Chicago Medicine, an experienced team of dermatologists, medical oncologists, surgeons and radiation oncologists will discuss your case and determine the best strategy to treat your cancer. If your home is not in the greater Chicago area, we will also communicate regularly with your local cancer team to co-manage your care.

Appointments: 1-855-702-8555

Early Melanoma Treatment

Early-stage melanomas that have not spread to the lymph nodes or other parts of the body (typically stages 0, 1A, 1B and 2B) are often cured with surgery alone to remove the tumor and some surrounding tissue. Types of surgery include:

• Wide local excision: Before this outpatient procedure, the surgeon will inject a local anesthetic, so you do not feel any pain. Then the surgeon will remove the tumor along with some normal-appearing tissue around the margins (borders). You will have stitches placed to repair the area, and you should restrict your activities for as long as your surgeon suggests.
• “Slow Mohs” micrographic surgery: This is an outpatient surgery for stage 0 and 1A early melanomas on parts of the body where a wide local excision is not possible, such as the head and neck or hands. During this procedure, a specially trained dermatologic surgeon removes thin layers of skin that are then specially processed in the lab over multiple days. The removed tissue is evaluated by our dermatopathologists under the microscope for any remaining melanoma. The repair of the site is typically delayed until the dermatopathology evaluation is completed.

Examining and Treating Lymph Nodes for Melanoma

If it is not clear if your melanoma has spread to your lymph nodes, our team may also recommend a sentinel lymph node biopsy (SNLB) to determine the stage of your melanoma and treat it.

During a sentinel lymph node biopsy, a surgeon will inject a special dye near your tumor and then test the closest lymph node for cancer. This procedure is typically performed under general anesthesia.

Advanced Melanoma Treatment

As recently as the 2010s, most patients with stage 3 and 4 melanomas did not survive more than a year. But new treatments have radically changed the outlook for people with advanced melanomas, offering a cure for more than half of patients. New therapies are also preventing melanoma from recurring.

We understand that waiting to see a doctor when you’ve been told you have advanced melanoma can be stressful. When you call for an appointment with our team, you can often see a surgeon and medical oncologist within a week. After the team reviews your case, we will work with you to determine the best treatment plan.

In addition to surgery to remove the tumor and affected lymph nodes, treatment may involve:

• Tumor-infiltrating lymphocyte (TIL) therapy: UChicago Medicine was among the first hospitals in the nation to offer this breakthrough therapy for melanoma. This FDA-approved treatment amplifies the body’s immune cells to fight melanoma.
• Talimogene laherparepvec (T-VEC) injections: Our team is also among the first cancer centers to offer this FDA-approved, outpatient treatment for melanoma tumors in or under the skin or in the lymph nodes that cannot be completely removed with surgery. During treatment, a doctor injects a tumor with a drug that uses a virus to infect and destroy cancer cells without harming healthy cells. Treatment involves several injections about every two weeks for six months or longer.
• Isolated limb infusion (ILI): During this minimally invasive treatment, a surgical oncologist will deliver high doses of chemotherapy through a catheter (small tube) to the limb while temporarily reducing blood flow in the treatment area. Patients who have ILI do not require incisions. UChicago Medicine is among a select group of hospitals to offer this treatment for nonsurgical stage 3 melanomas in an arm or leg.
• Immunotherapy: Innovative medications called checkpoint inhibitors (pembrolizumab, nivolumab and ipilimumab) are one type of immunotherapy to treat melanoma. These drugs harness your body’s own tumor-fighting cells known as T cells to destroy cancer. UChicago Medicine researchers were among the country’s first to test these therapies in clinical trials and were early adopters of using immunotherapy before surgery (neoadjuvant immunotherapy) to help prevent recurrence. With this therapy, our medical oncologists can “train” your immune system to remember the tumor before it is removed, so it will fight future cancer cells that may appear.
• Targeted therapies: Targeted therapies like BRAF inhibitors (dabrafenib, vemurafenib and encorafenib) and MEK inhibitors (trametinib, cobimetinib and binimetinib) target specific proteins in tumors to control the spread of melanoma. These FDA-approved medications make it more difficult for cancer cells to grow and spread throughout the body.
• Radiation therapy: Our team may suggest radiation to treat melanoma that has spread to your organs. Using high doses of energy, our radiation oncologists can shrink tumors and reduce symptoms. At UChicago Medicine, we use image-guided technology to target the radiation with precision, focusing the radiation on tumors while minimizing exposure to healthy tissue. Some of these treatments include stereotactic radiosurgery (SRS) for melanoma that as spread to the brain and stereotactic body radiation therapy (SBRT) for melanoma tumors that have spread to the lung or liver.
• Chemotherapy: Sometimes, chemotherapy may be an option if you have melanoma. But in most cases, your team will suggest other treatments first. Chemotherapy is not as effective against melanoma as it is against other cancers.
• Clinical Trials: UChicago Medicine is widely considered to be a national leader in research on new treatments for melanoma. These include promising regional therapies as well as new melanoma vaccines and immunotherapies for patients with advanced melanoma that won’t respond to standard therapies. For example, our team is testing new checkpoint inhibitors that block proteins made by immune cells to prevent them from “turning off” so they can continue to fight cancer. As a patient at UChicago Medicine, you may benefit from these breakthrough treatments before they are widely available.

Depending on your melanoma, our care team may recommend a combination of treatments for you. Our pathologists can also perform the latest molecular tests to determine if you are at risk for developing advanced or recurrent melanomas. Armed with this knowledge, your entire care team can design an effective treatment plan to reduce your risks.

Expert Care for Recurrent Melanoma

If you have a recurrence of melanoma, we are here to provide solutions and support. Because our multidisciplinary care team can offer more therapies than most hospitals — including the full range of FDA-approved treatments as well as innovative treatments through clinical trials — you may have more options than you think.

We also welcome second opinions on your cancer care and can work with your regular care team on a personalized care plan to treat recurrent melanoma. Our dermatopathologists can also provide second opinions on difficult pigmented lesions.

Specialized Care for Uveal and Mucosal Melanomas

UChicago Medicine was among a handful of U.S. medical centers to participate in a clinical trial of a groundbreaking therapy for uveal melanoma, a rare type of melanoma that forms in the back of the eye. This new intravenous therapy, called tebentafusp-tebn, is FDA-approved and available at UChicago Medicine. Read one patient’s story about how tebentafusp-tebn has kept her healthy and active.

Our team also has extensive experience managing mucosal melanoma, another rare type of melanoma that affects the mucous membranes. Given the challenging location of these tumors inside the body, our medical oncologists work closely with our surgeons to develop the best care plan that minimizes side effects from treatments. One promising option is TIL therapy, which can treat refractory, metastatic mucosal melanoma.