Melanoma Treatment Planning
Following a diagnosis of melanoma, we work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your needs. We try to maximize treatment success while minimizing the impact that diagnosis and treatment can have on your life.
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
Considering Your Options »
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
Assessment
Evaluating Options
Choosing Treatment
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the melanoma
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of melanoma you have: cutaneous (skin), regional lymph nodes, or distant metastatic disease
- Genetic information about the certain mutations that may or may not be present in your melanoma (generally performed only for advanced disease)
About Melanoma » - Your age and overall health
- Whether you have had cancer before
- Other considerations which may impact your treatment plan.
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment. These include surgery (the main therapy for skin melanoma) and drug therapy (targeted therapy depending on mutations in the melanoma, and only for more advanced disease (regional lymph node involvement or distant metastatic sites). This includes the use of medications that travel through the bloodstream to attack cancer anywhere in the body. Radiation therapy is sometimes used in the setting of more advanced melanoma to enhance local control of the tumor and may also be combined with immunotherapies to increase the chance of cure. The combination of treatment types may need to take place in a specific order to treat your melanoma most effectively.
Learn about treatments for melanoma »
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of melanoma, from the least to the most severe.
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you. A cutaneous, surgical, and/or medical oncologist leads your team (based on the stage of your melanoma) and remains your main doctor throughout treatment. Patients are often seen by multiple specialists throughout their initial cancer care and follow-up.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for melanoma have different goals, such as:
- Destroying or surgically removing cancer cells in the skin to increase the chance of cure
- Destroying or surgically removing any cancer cells that may have spread to other parts of the body
- Slowing or stopping the growth of cancer
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer or those related to treatment of advanced disease
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing melanoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the melanoma
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of melanoma you have: cutaneous (skin), regional lymph nodes, or distant metastatic disease
- Genetic information about the certain mutations that may or may not be present in your melanoma (generally performed only for advanced disease)
About Melanoma » - Your age and overall health
- Whether you have had cancer before
- Other considerations which may impact your treatment plan.
close Assessment
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment. These include surgery (the main therapy for skin melanoma) and drug therapy (targeted therapy depending on mutations in the melanoma, and only for more advanced disease (regional lymph node involvement or distant metastatic sites). This includes the use of medications that travel through the bloodstream to attack cancer anywhere in the body. Radiation therapy is sometimes used in the setting of more advanced melanoma to enhance local control of the tumor and may also be combined with immunotherapies to increase the chance of cure. The combination of treatment types may need to take place in a specific order to treat your melanoma most effectively.
Learn about treatments for melanoma »
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of melanoma, from the least to the most severe.
close Evaluating Options
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you. A cutaneous, surgical, and/or medical oncologist leads your team (based on the stage of your melanoma) and remains your main doctor throughout treatment. Patients are often seen by multiple specialists throughout their initial cancer care and follow-up.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for melanoma have different goals, such as:
- Destroying or surgically removing cancer cells in the skin to increase the chance of cure
- Destroying or surgically removing any cancer cells that may have spread to other parts of the body
- Slowing or stopping the growth of cancer
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer or those related to treatment of advanced disease
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing melanoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
close Choosing Treatment
Every cancer is different, even in the early stages. The best treatment for one person might not be the best treatment for another. Your doctor will help you make an informed decision about which options may be right for you. Your treatment plan may consist of one or any combination of the following:
- Regular monitoring by your care team
- Surgery
- Drug Therapy (Medical Oncology)
- Radiation Oncology
- Clinical Trials
Surgery
Your care team may recommend surgery to diagnose, stage, or treat cancer:
- Diagnosis: Your doctor may recommend that you have a biopsy, to obtain tissue samples and determine a more precise diagnosis. Most patients with melanoma have already had a diagnostic skin biopsy, but additional biopsies may be recommended if there are other skin lesions of concern, or if any enlarged lymph nodes are present.
- Staging: Surgery and sentinel lymph node biopsy can help determine the stage of melanoma, by showing the thickness of the skin tumor and other details, as well as whether nearby (regional) lymph nodes are involved at the outset.
Surgery Resources
Should surgery be part of your care plan, we are here to help guide you through the process.
- Treatment: Surgically removing the tumor from the skin provides the best chance for cure in most cases of melanoma.
If surgery provides a good treatment option, you will meet with a dermatologic surgeon or surgical oncologist to develop a plan. Surgery for melanoma is different for every patient, and depends on the thickness and stage of your melanoma. Your surgeon will work with you to determine the least invasive and most effective surgery for the type of melanoma you have.
Combining surgery with other treatments
To achieve the best possible outcome, your care team may recommend combining surgery with other treatments such as drug therapy, and less commonly, radiation therapy.
Drug Therapy (Medical Oncology)
Drug therapy, also called systemic or medical therapy, is treatment that works throughout the body to fight melanoma. These drugs slow the growth of cancer cells or destroy them by using your immune system. Drug therapy may consist of a topical skin cream (administered by a dermatologist), targeted drug therapy, or immunotherapy (administered by a medical oncologist)
The recommended choice depends on the melanoma stage and other factors.
Types of Drug Therapy for Melanoma
At Stanford, our cutaneous and medical oncologists use several types of drug therapy, including:
Topical medications: One type of topical immunotherapy cream can be used to treat a very superficial type of melanoma called melanoma in situ, but usually when surgery is not possible. Various topical medications may also be used to treat skin infections or rashes that can occur during treatment for your melanoma. Our Supportive Dermato-Oncology team can help to address any uncomfortable skin side effects you are having related to your cancer therapy.
Topical Medication Resources
Topical medications treat superficial melanomas at the tumor site. We are here to help you prepare and guide you through the process.
Chemotherapy: This group of medications is now much less commonly used for treatment of melanoma and has been replaced by targeted therapy and newer immunotherapy agents (checkpoint inhibitors). Chemotherapy stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. While powerful, chemotherapy can cause more side effects than other medication types, because it cannot distinguish between cancerous and healthy cells. Chemotherapy has a limited role in patients with advanced melanoma who do not respond to other therapies.
Chemotherapy Resources
Chemotherapy is a treatment option for some progressed melanomas. We are here to help you prepare and guide you through the process.
Targeted therapy: Medications that target certain gene mutations on cancer cells to block their growth, without harming nearby tissues.
For treatment to work, the cancer must have the specific markers a particular medication was designed to target. Some melanoma cells have certain mutations in the cells that promote growth and can cause cancer to spread. Our pathologists look for the presence of these mutations by examining samples of tissue taken during a biopsy or other surgical procedure.
Targeted Therapy Resources
If targeted therapy is a part of your care plan, we are here to help you prepare and guide you through the process.
Immunotherapy: These medications fight cancer by either stimulating the immune system or by targeting specific molecules on cancer cells.
Immunotherapy Resources
If immunotherapy is a part of your care plan, we are here to help you prepare and guide you through the process.
Drug therapy scheduling
If your treatment plan involves drug therapy, you will have routine visits to have lab work done, see your doctor, and receive medication. You may need to come in once or twice per week. If you need an infusion, you will visit one of Stanford’s infusion treatment centers, where a nurse specializing in Melanomama care will provide your treatment.
Drug therapy side effects
Side effects from drug therapies vary depending on the type of medication you receive. For example, immunotherapy can cause itchy skin rashes or autoimmune-like symptoms, because it stimulates your immune system to attack the cancer. Targeted therapy has different side effects in the body, and chemotherapy (though much less commonly used for melanoma these days) may affect your hair and nails, because it slows their growth as it slows the growth of cancer cells. Fatigue is also possible. Ask your care team – we can help you manage or prevent many symptoms and side effects that can affect your everyday life.
Radiation Oncology
Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our radiation oncologists have years of experience safely and effectively treating melanoma with radiation, athough this treatment is used less these days due to better systemic (drug) therapies. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.
Radiation therapy may provide effective local control depending on the type of melanoma you have. Radiation therapy has also been used successfully with immunotherapy in the setting of advanced disease to promote the chance for cure. If your are a candidate for radiation therapy, your doctor will speak with you about the best options. The types of radiation therapy we use for melanoma treatment at Stanford include:
Radiation Therapy Resources
Should radiation therapy be part of your care plan, we are here to help you prepare and guide you through the process.
What to expect during external radiation therapy and how to prepare »
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are found. Some of the types of external radiation we use include:
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer. - Intensity-modulated radiation therapy (IMRT)
This method is similar to the first method, but the doctor can adjust how much radiation you get from each beam. In certain situations, this enables the doctor to avoid nearby normal cells to reduce the risk for side effects. - Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method works like the first two methods, and the total amount of radiation you get is similar. But with SBRT, the radiation is given in fewer but stronger doses. This is often used for melanomamas or other cancers.
Receiving radiation treatments
Radiation therapy does not cause pain, so you won’t feel anything during your treatments. Radiation does not make you radioactive, and you can safely be around other people, including children.
The exact number and timing of your radiation treatments depends on the type of melanomama you have and the type of radiation therapy you need:
- Typically, you will be treated once a day, Monday through Friday, over a few weeks.
- Most treatment sessions take 15 to 30 minutes, but some may take up to 1 hour.
- We offer treatment sessions between 8 a.m. and 5 p.m. at our Cancer Centers in Palo Alto, Pleasanton, South Bay, and Turlock.
Radiation therapy side effects
Everyone has a different response to radiation therapy. It may cause short-term side effects during treatment or long-term side effects after treatment ends.
The side effects of treatment depend on the type of radiation you receive, the dose, and your overall health. Common side effects that you may experience after radiation treatment include:
- Fatigue
- Skin color changes, like a tan or sunburn
- Skin irritation
- Skin side effects from radiation therapy are often managed in the Supportive Dermato-Oncology Clinic, in conjunction with Stanford Radiation Oncology.
No matter what you experience, your care team can help ease the side effects of treatment. At least once a week, your radiation oncology team will meet with you to discuss your progress and any side effects that you may have.
Clinical Trials
At Stanford, our doctors are always working to improve care for people with melanoma. As an academic medical center, we conduct clinical trials to evaluate new medical techniques, devices, medications, and other treatments for safety and effectiveness.
For melanoma, we study new approaches to preventing, screening, detecting, diagnosing, and treating melanomama. Some clinical trials look at new methods, while others evaluate new combinations of approved, existing approaches.
Depending on your individual circumstances, a clinical trial may provide a treatment option for you. Like any treatment, clinical trials have possible risks and benefits, including:
Possible benefits of joining a clinical trial:
- Access to a new treatment that isn’t widely available
- Expert care from our world-renowned cancer specialists and their teams
- Low- or no-cost treatment
- Participation in research that can save lives in the future
Possible risks of a clinical trial:
- Treatment that may not work for you
- Side effects that may be unexpected or worse than current standard-of-care treatments
- Additional doctor visits, meaning more time and travel
- Additional tests, which may be uncomfortable or time consuming
- Extra expenses if your health insurance does not cover all patient costs for a trial
To learn more about Stanford’s clinical trials for melanomama, speak with your care team. We can help you decide if a clinical trial may be right for you.
Stage 0
Stage I
Stage II
Stage III-Stage IV
In this stage, melanoma is confined to the top layer of skin (epidermis) and so cancer cells can’t spread into blood vessels or lymph channels in the deeper layer of the skin (dermis). Surgery or other therapies are generally curative.
In this stage, melanomas are no more than 1 or 2 millimeters thick and have not spread to nearby (regional) lymph nodes. Stage I melanoma is divided into stage IA and stage IB depending on the thickness of the melanoma and whether or not it is ulcerated under the microscope. Most patients with melanomas less than 1 mm thick are treated by dermatology surgeons, where as those with thicker melanomas may undergo the sentinel lymph node biopsy by a surgical oncologist to see if any cancer cells involve the nearby lymph nodes.
In this stage, the skin melanoma is over 2 mm thick, and surgery of the skin tumor and staging of the regional lymph nodes is generally recommended at the outset. Stage II melanoma is divided into stage IIA, IIB, and IIC depending on the thickness of the melanoma and whether or not it is ulcerated under the microscope.
Stage III
In this stage, melanoma has spread to the nearby (regional) lymph nodes, generally detected by the sentinel lymph node biopsy. Microscopically detected lymph nodes may be a reason to perform additional lymph node surgery (called a completion lymph node dissection), though this is less commonly done now. If the lymph nodes are enlarged though, surgery is generally done to remove those lymph nodes and others in the regional nodal basin (called a therapeutic lymph node dissection). Drug therapy after surgery (called adjuvant therapy) may be recommended.
Stage IV
In this stage, melanoma has spread to distant sites, including the skin, lymph nodes (beyond the regional nodes), lungs, liver, or brain. Metastatic melanoma cannot always be cured, but great improvements in drug therapy have occurred over the past decade to help people live longer and be more comfortable. Newer immunotherapy and targeted agents have resulted in many cures and are actively being studied in clinical trials to be even more successful.
In this stage, melanoma is confined to the top layer of skin (epidermis) and so cancer cells can’t spread into blood vessels or lymph channels in the deeper layer of the skin (dermis). Surgery or other therapies are generally curative.
close Stage 0
In this stage, melanomas are no more than 1 or 2 millimeters thick and have not spread to nearby (regional) lymph nodes. Stage I melanoma is divided into stage IA and stage IB depending on the thickness of the melanoma and whether or not it is ulcerated under the microscope. Most patients with melanomas less than 1 mm thick are treated by dermatology surgeons, where as those with thicker melanomas may undergo the sentinel lymph node biopsy by a surgical oncologist to see if any cancer cells involve the nearby lymph nodes.
close Stage I
In this stage, the skin melanoma is over 2 mm thick, and surgery of the skin tumor and staging of the regional lymph nodes is generally recommended at the outset. Stage II melanoma is divided into stage IIA, IIB, and IIC depending on the thickness of the melanoma and whether or not it is ulcerated under the microscope.
close Stage II
Stage III
In this stage, melanoma has spread to the nearby (regional) lymph nodes, generally detected by the sentinel lymph node biopsy. Microscopically detected lymph nodes may be a reason to perform additional lymph node surgery (called a completion lymph node dissection), though this is less commonly done now. If the lymph nodes are enlarged though, surgery is generally done to remove those lymph nodes and others in the regional nodal basin (called a therapeutic lymph node dissection). Drug therapy after surgery (called adjuvant therapy) may be recommended.
Stage IV
In this stage, melanoma has spread to distant sites, including the skin, lymph nodes (beyond the regional nodes), lungs, liver, or brain. Metastatic melanoma cannot always be cured, but great improvements in drug therapy have occurred over the past decade to help people live longer and be more comfortable. Newer immunotherapy and targeted agents have resulted in many cures and are actively being studied in clinical trials to be even more successful.
close Stage III-Stage IV
Your melanoma care team includes doctors who specialize in diagnosing melanoma, removing in with surgery, or treating it with drugs chosen to be most effective.
- Dermatologists/Cutaneous Oncologists: doctors who specialize in the diagnosis and treatment of skin cancers; Supportive Dermato-oncologists specialize in treating skin side effects from advanced cancer treatment and work to make patients more comfortable so that they can continue their cancer therapy
- Surgical oncologists: Cancer surgeons who remove thicker melanoma, perform lymph node biopsies and surgery for more advanced melanoma
- Medical oncologists: Cancer doctors who treat advanced melanoma with drugs
- Pathologists/Dermatopathologists: doctors who specialize in evaluating skin tissue to diagnose melanoma
- Genetic counselor/skin cancer genetic specialists: Health care professional trained in cancer genetics and testing
Your treatment plan will address the following:
- Location, size, and stage of the cancer
- Treatment goals
- Treatment options, their possible side effects, and ways to minimize or relieve side effects
- Expected length of treatment
- Follow-up care after treatment
If you have metastatic melanoma
Metastatic melanoma means that cancer cells have spread to nearby lymph nodes to other parts of the body. Your melanoma may have started on the skin and then recurred, years after initial surgical treatment. Most patients don’t present with metastatic melanoma, but rather, melanoma confined to the skin.
Your appointment timing depends on your treatment goals:
• If you need treatment for a diagnosis of recurrent or metastatic melanoma, you will generally see a surgical oncologist for consideration of surgery to remove the melanoma (if indicated) and a medical oncologist for consideration of drug therapy (after or instead of surgery). These appointment are generaly scheduled within 7 days of your referral to Stanford. Recurrent disease refers to melanoma that has come back in the skin, soft tissue or regional lymph nodes or spread to another part of the body.
• If you are interested in clinical trials for metastatic disease, you will see a medical oncologist for drug therapy within 7 days.
• If you need a second opinion of a diagnosis, you will see a medical oncologist within 14 to 21 days.
Learn more about stage 4 melanoma »
If you already have a diagnosis of melanoma and want a second opinion about treatment options, we can usually schedule you within 7-14 days. Your reason for seeking a second opinion may help us determine which specialist you should see.
• If you are still deciding where you will receive treatment, you will see a cutaneous oncologist and surgeon (for earlier stage disease) vs a medical oncologist and a surgeon for more advanced melanoma.
• If you need a second opinion about drug therapy, you will see a medical oncologist.
• If you need a second opinion about surgery, you will see our core doctors.