Melanoma

Treatment

Fred Hutchinson Cancer Center experts offer comprehensive melanoma care at the Multidisciplinary Skin Oncology Clinic, including advanced treatments and new options available only through clinical studies.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.

Melanoma expertise at Fred Hutch

Everything you need is here

We have dermatologists, surgeons, medical oncologists and radiation oncologists who specialize in melanoma. As a member institution of the National Comprehensive Cancer Network, Fred Hutch is home to doctors who help define the national standards for melanoma care. 

Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Radiation oncologist A physician who has special training in using radiation to treat cancer.
Innovative melanoma therapies

Fred Hutch patients have access to advanced therapies being explored in clinical studies for melanoma conducted here and at UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.
Melanoma treatment tailored to you

We view treatment as a collaborative effort. Your Fred Hutch doctors will explain all your options and recommend a treatment plan based on the type, location, size and stage of your cancer and your overall health.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Team-based approach

Your personal team includes more than your melanoma doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a palliative care professional, social worker, physical therapist, dietitian or integrative medicine provider.

Learn More About Supportive Care Services

Integrative medicine Combines conventional (standard) medical treatment with complementary and alternative (CAM) therapies that have been shown to be safe and to work. CAM therapies treat the mind, body and spirit. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.
Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as a melanoma survivor.

Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Surgery

Surgery is usually the main treatment for melanoma. Often this means your primary care doctor or dermatologist removes suspicious tissue, and has it checked for cancer (biopsied), before you ever see a specialist at Fred Hutch. If your tumor is removed very early, you may not need any other treatment. 

Melanoma-specialized surgeons

Our skin cancer surgeon team includes experts in surgical oncology, reconstruction and head and neck surgery. This team specializes in the treatment of melanoma and you can feel confident knowing that the surgeon who cares for you is best-suited for your specific diagnosis.

Wide excision

If your melanoma is localized, meaning it is just on your skin, you may need only a simple excision (removing it by cutting it out).

  • Your doctor removes the tumor, along with a margin of normal-looking skin around the tumor. If the melanoma is thicker, your surgeon will have to cut wider margins. This is important so that the melanoma does not grow back at the original location later. 
  • If the doctor did not take wide margins during your original biopsy, you may need another excision to remove more skin, including very small lymph vessels near the tumor where cancer cells might have spread.
  • Depending on where your melanoma is and how large the margins need to be, you might need only a local numbing medicine or you might have general anesthesia.

Fred Hutch’s melanoma surgeons and reconstructive surgeons work together to treat tumors in sensitive locations, like the face or hand. The surgeon who removes the cancer may be able to close the area by bringing the edges of the skin together around the wound. If the area is too large or the cancer went too deep for this approach, our reconstructive surgeons offer more options. One is closing the wound with neighboring skin that is turned into place (local tissue rearrangement). Others involve using skin from another part of your body (skin grafting) or using skin plus other tissue from another body area (free-flap reconstruction). Learn more about reconstructive surgery.

Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines.
Dr. David Byrd discusses surgery for melanoma
Dr. David Byrd discusses how we treat melanoma on different parts of the body

Sentinel lymph node mapping and biopsy 

Thicker melanomas tend to spread to nearby lymph nodes, which need to be checked for cancer and possibly removed.

A tracer substance and a dye are injected near your tumor to find the lymph node or nodes where your cancer would spread first (sentinel nodes). Your surgeon removes only the nodes where the substance appears, and a pathologist checks the nodes for cancer cells. 

  • If cancer is found, your surgeon removes the lymph nodes in that area.
  • If cancer is not found, the rest of your lymph nodes will be left in place.

Fred Hutch's David R. Byrd, MD, brought this technique, sentinel lymph node mapping and biopsy, to the Northwest in the 1990s. 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope.
Dr. David Byrd discusses the sentinel node biopsy in assessing and treating melanoma

Preventing and treating lymphedema

Lymphedema is not common, but it is a possible complication. So after any lymph node surgery, we refer our patients to physical therapists (PTs) with expertise in preventing, detecting and managing lymphedema.

We have several resources for lymphedema treatment, including PTs who provide complete decongestive therapy and specialized reconstructive surgeons who offer advanced surgical treatments, such as lymph vessel reconnection surgery and lymph-node transfer.

Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery.
Dr. David Byrd discusses the role of pathology in the treatment of melanoma
Surgery

Surgery is usually the main treatment for melanoma. Often this means your primary care doctor or dermatologist removes suspicious tissue, and has it checked for cancer (biopsied), before you ever see a specialist at Fred Hutch. If your tumor is removed very early, you may not need any other treatment. 

Immunotherapy

Immunotherapies harness your body’s immune system to fight your cancer. One type is called an immune checkpoint inhibitor. These medicines block proteins that normally keep your immune cells in check so that they do not become overactive.

Immune checkpoint inhibitors used for melanoma include:

  • Pembrolizumab (Keytruda) and nivolumab (Opdivo) — These block the protein PD-1, taking the brakes off your T cells and allowing these immune cells to attack your cancer.
  • Ipilimumab (Yervoy) — This medicine targets a different protein, CTLA-4. It is sometimes used in combination with pembrolizumab or nivolumab.

Other types of immunotherapy for melanoma include:

  • T-VEC therapy — This is a genetically engineered virus that is injected into melanoma tumors. The virus kills the melanoma cells and triggers an immune response that helps in the clearance of cancer cells. T-VEC is also known as talimogene laherparepvec or Imlygic.
  • Imiquimod (Aldara) — This is a cream you rub on your skin.

Learn More About Immunotherapy

Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. T cell A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. Also called T lymphocyte and thymocyte.
Immunotherapy

Immunotherapies harness your body’s immune system to fight your cancer. One type is called an immune checkpoint inhibitor. These medicines block proteins that normally keep your immune cells in check so that they do not become overactive.

Targeted therapy

Targeted therapies work selectively against cancer cells, rather than affecting all fast-growing cells, like standard chemotherapy does). Many of them target a gene or protein responsible for allowing cancer to grow.

Target therapies for melanoma include:

  • BRAF inhibitors — Medicines that block the BRAF protein, such as vemurafenib (Zelboraf), dabrafenib (Tafinlar) and encorafenib (Braftovi).
  • MEK inhibitors — Medicines that block the MEK protein, such as trametinib (Mekinist), cobimetinib (Cotellic) and binimetinib (Mektovi)

Your Fred Hutch team will talk with you about the specific immunotherapies or targeted therapies we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy

Targeted therapies work selectively against cancer cells, rather than affecting all fast-growing cells, like standard chemotherapy does). Many of them target a gene or protein responsible for allowing cancer to grow.

Radiation therapy

Radiation therapy is often given to people with melanoma:

  • After surgery to decrease the odds of cancer returning
  • To prevent or relieve symptoms if cancer has spread to multiple parts of the body, especially the brain or bones

Radiation therapy is painless and noninvasive (similar to getting a CT scan), and each treatment lasts only minutes. Different types of radiation therapy are used for different situations.  A few examples are described below.

Radiosurgery

Radiosurgery is an advanced form of highly focused, high-dose radiation therapy that can kill tumors in fewer treatments than conventional radiation treatment — typically one to five session rather than daily sessions for several weeks. It has a greater than 95 percent chance of killing small tumors.

There are many names for this type of treatment, including:

  • Stereotactic body radiation therapy (SBRT)
  • Stereotactic ablative body radiotherapy (SABR)
  • CyberKnife or GammaKnife, brand names

Gamma Knife is specifically designed for treating tumors in the brain. It is not a knife or scalpel in the usual sense of the word (neither is CyberKnife), and it doesn’t require opening the skull. Instead, it uses precisely focused beams of radiation. Patients are usually treated in one session.

Intensity-modulated image-guided radiotherapy (IMRT/IGRT)

In this form of radiation treatment, doctors use computed tomography (CT) to scan your tumor and create beams of radiation that closely conform to the tumor's shape. The beams vary in shape and intensity to deliver a higher dose of radiation to the tumor and lower doses to nearby healthy tissue.

IMRT/IGRT is generally used after surgery if there’s a high risk the cancer might recur, such as if multiple lymph nodes in the neck are involved.

Neutron therapy

Neutron therapy is a strong form of radiotherapy used for advanced melanomas that cannot be removed by surgery. It also helps with pain and other symptoms when melanoma is widespread.

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recur To come back. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Radiation therapy

Radiation therapy is often given to people with melanoma.

Proton therapy for ocular melanoma
Dr. Rengan and Dr. Stacey, and their patient, Bob Martin, talk about the Ocular Melanoma Program at UW Medicine and Fred Hutch - Proton Therapy, a comprehensive approach to treating ocular cancers.

Treatment options for ocular cancers

The recommended treatment for eye tumors is based on the location and the size of the tumor. There are four treatment approaches for ocular melanoma.

Laser

If the tumor is small, laser treatment is sometimes an option.

Surgical enucleation (removal of the eye)

This is usually required if the tumor is very large. Outcomes are excellent for tumor control, but the side effect is the loss of the eye. For additional details, contact an ocular oncologist.

Brachytherapy

A large comparative study of patients with medium-size tumors found that brachytherapy was a good equivalent option to enucleation. It is now routinely used to treat all but the largest tumors and reservation of the eye is a priority.

Proton therapy

Proton therapy is comparative in outcomes to brachytherapy and enucleation. Proton therapy is very effective in achieving local control of the melanoma, and does not worsen survival rates for the patient. It can be used to treat tumors too large for brachytherapy and is well suited to treating tumors next to the optic nerve. Ocular melanoma is one of the earliest uses of proton therapy and has been used to treat ocular cancers in the United States since 1994.

Protons can be controlled with greater precision than X-rays. This means that more energy goes into destroying the tumor and less radiation is delivered to surrounding healthy tissue. For this reason, proton therapy is particularly good for treating tumors near healthy organs, including melanoma of the eye.

Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
ocular melanoma proton therapy

In the left-hand image above, you can see a typical proton beam treatment plan for ocular cancer. The right-hand image shows typical treatment with X-rays.

Please call 1-844-538-3485 if you are ready to request an appointment. Please be advised that we will need your medical records to determine if you are a candidate for proton therapy.

Proton therapy for ocular melanoma

Ocular melanomas are the most common type of eye tumors. Historically, melanomas of the eye were treated by completely removing the eye. Since the mid-1970s, however, proton therapy has been used to treat melanoma of the eye without removing the eye and with less damage to the cornea, lens, retina, fovea, or optic nerve. Studies show that patients treated with protons have long-term survival rates equal to that of patients who have had an eye removed. Furthermore, most patients in these studies have retained useful vision in the treated eye.