Treatment Options for Melanoma
The primary treatment for melanoma is surgical excision with appropriate margins based on the depth of invasion, with additional treatments determined by staging and risk factors. 1
Surgical Management
- Wide local excision is the standard primary treatment for melanoma with safety margins determined by tumor thickness: 0.5 cm for in situ melanomas, 1 cm for tumors up to 2 mm thick, and 2 cm for thicker tumors 1
- Sentinel lymph node biopsy (SLNB) is recommended for melanomas with a tumor thickness >1 mm and/or ulceration for accurate staging 1, 2
- Complete lymph node dissection (CLND) is NOT recommended for sentinel node-positive patients but IS indicated for clinically detectable (macroscopic) lymph node metastases 1
- Mohs surgery is NOT a standard procedure for melanoma treatment - this technique is primarily used for non-melanoma skin cancers 2, 3
Treatment by Stage
Early Stage Melanoma (Stage 0-IIA)
- Stage 0 (in situ) and early-stage melanoma (Stage IA, ≤1 mm without adverse features): Primary excision alone is typically curative 1
- Stage IB or II (≤1.0 mm with ulceration or Clark level IV-V, or ≥1.0 mm thick): Wide excision with appropriate margins 1
- No adjuvant therapy is standard for stage IA; observation is recommended 1
Intermediate Stage Melanoma (Stage IIB-IIC)
- Wide excision with 2 cm margins 1
- Adjuvant options include anti-PD-1 immunotherapy (pembrolizumab or nivolumab) which has shown improved recurrence-free survival 1, 2
Advanced Melanoma (Stage III-IV)
- Stage III: Surgical management plus adjuvant therapy 1
- Adjuvant options include anti-PD-1 therapy (nivolumab, pembrolizumab) or BRAF/MEK inhibitor combination (dabrafenib/trametinib) for BRAF-mutated melanoma 1, 2
- Stage IV (metastatic): Treatment depends on whether disease is limited (resectable) or disseminated (unresectable) 1
- For limited metastatic disease: Surgical resection when feasible 1
- For disseminated disease: Systemic therapy options include anti-PD-1 antibodies (pembrolizumab, nivolumab), combination of PD-1 and ipilimumab, or BRAF/MEK inhibitors for BRAF-mutated melanoma 1
Important Clarifications
- Dermabrasion or chemical peels are NOT appropriate treatments for melanoma - these are cosmetic procedures used for conditions like acne scarring or melasma, not for treating skin cancer 4, 5
- Lymph node resection during Mohs surgery is NOT standard practice - Mohs surgery is not typically used for melanoma, and lymph node assessment is done through sentinel lymph node biopsy as a separate procedure 3, 6
- Melanoma treatment is NOT limited to "small excision with local anesthetic" - the extent of surgery depends on tumor thickness and staging 1, 2
- Eight weeks of radiation therapy is NOT a standard primary treatment for melanoma - radiation is primarily used in specific situations such as for palliation of symptoms or local control in cases of inadequate margins 1
Follow-up Care
- Lifelong regular skin self-examinations and professional skin checks are recommended 1
- Patients should be educated about sun protection and avoidance of UV exposure 1, 5
- Family members should be informed of their increased melanoma risk 1
- Follow-up schedules vary, but typically include visits every 3 months during the first 3 years and every 6-12 months thereafter 1
- Imaging studies may be appropriate for high-risk patients but are not routinely needed for those with thin primary melanomas 1