Melanoma Treatments

Melanoma is a very serious form of skin cancer, but it is often very treatable- especially when found early. At Columbia, your care starts with a thorough evaluation to begin your personalized treatment plan carefully designed around the type of melanoma you have, whether it has spread, and your overall health. 

At Columbia’s Melanoma Center, you’ll be cared for by a team of specialists with deep expertise in every type of melanoma and the latest treatment options. We’ll work closely with you to ensure your treatment reflects your values and preferences and gives you the best possible outcome—while helping you stay active, informed, and supported at every step.

Treatment may include one or more of the following: 

• Surgery
• Immunotherapy  
• Targeted therapy
• Chemotherapy 
• Radiation therapy
• Participation in clinical trials
• Supportive care

Surgery

Surgery is the most common and effective treatment for early-stage melanoma. It removes the tumor and, when needed, nearby lymph nodes to prevent further spread. In many cases, no further treatment is needed after surgery. 

The following are the most common types of surgery used to treat melanoma.

Wide Excision

A wide excision removes the melanoma and a small margin of healthy tissue to ensure complete removal. It’s often done under local anesthesia and may include stitching the skin back together or using a skin graft for larger areas.

Lymph Node Dissection

If the initial biopsy shows that the melanoma has spread to nearby lymph nodes, they may be surgically removed. This helps prevent further spread and provides more information about the stage of the cancer. 

Mohs Surgery

Mohs surgery is the single most effective technique for removing basal cell and squamous cell carcinomas and is now proving an effective way to remove melanoma in situ (contained skin cancers). This surgery spares the greatest amount of healthy tissue with a 98% cure rate. 

The procedure allows the surgeon to remove one thin layer of tissue at a time, checking it under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is completed. If not, more tissue is removed from the margin until the sample is clear of cancer. 

Surgery is the only treatment necessary for in situ melanomas.

Medication Therapy for Melanoma

When melanoma has spread or surgery is not enough, several medication-based therapies may be used.

Chemotherapy 

Chemotherapy uses strong drugs to kill melanoma cancer cells throughout the body. It is usually reserved for advanced melanomas when other treatments have not been effective. This is generally because chemotherapy is not as effective as immunotherapy or targeted therapy in treating melanoma. Chemo drugs can be given as pills, through an IV, or in specialized procedures like isolated limb perfusion (ILP) or isolated limb infusion (ILI), which limit the treatment to one area like an arm or leg. This helps make the medicine more effective and reduces its effects on the rest of the body. 

Immunotherapy 

Immunotherapy helps boost your immune system to recognize and fight melanoma cells. The most common types are checkpoint inhibitors (such as nivolumab, pembrolizumab, and ipilimumab), which block cancer’s ability to hide from your immune system. Another option includes a cutting-edge therapy called IL-2, which boosts the production of cancer-fighting T-cells in your body. 

In some cases, oncolytic virus therapy such as TVEC may be used. This modified virus is injected directly into melanoma tumors to trigger an immune response that helps the body recognize and destroy melanoma cells—both at the injection site and throughout the body. 

Targeted Therapy 

Melanoma tumors often contains many genetic mutations - changes in the DNA that help cancer cells grow, spread, and resist treatment. Targeted therapies attack specific genetic mutations that help melanoma grow. These drugs are usually given as pills, and your care team will test your tumor for mutations before deciding which therapy will be most effective. 

• BRAF mutations: One of the most common mutations is in a gene called BRAF, which sends signals that tell cells to grow. When mutated, BRAF can stay “switched on,” causing melanoma cells to grow uncontrollably. Targeted drugs can block this faulty signal, stopping or slowing tumor growth. 
• KIT mutations: Another mutation occurs in the KIT gene, especially in certain melanoma types like those found on the palms, soles, or inside the mouth. Blocking this gene’s abnormal activity can reduce or shrink tumors in some patients. 
• NRAS mutations: These mutations drive melanoma growth in some people and may respond to MEK inhibitors, sometimes in combination with other drugs. These cases are more complex to treat, but targeted drugs are sometimes used to interfere with downstream pathways that support tumor growth. 

These treatments can be highly effective with fewer side effects compared to traditional chemotherapy.

Radiation Therapy

Radiation uses high-energy beams (like X-rays) to kill cancer cells or shrink tumors. Radiation may be used after surgery to prevent recurrence or to treat areas where surgery isn’t possible. 

Radiation can also be delivered internally, or from within the body. This type of treatment is not as common for melanoma but may be used if the cancer has spread to areas of the body that would be difficult to reach using an external machine.  At Columbia, we offer the most advanced and cutting-edge radiation therapies such as: 

• External beam radiation therapy (EBRT) 
• 3D conformal radiation therapy 
• Image-guided radiation therapy (IGRT) 
• Intensity-modulated radiation therapy (IMRT) 
• Stereotactic body radiation therapy (SBRT) 
• Brachytherapy eye plaque, for ocular melanoma

Follow-Up Care for Melanoma

After treatment, you will continue to be cared for through regular follow-ups to monitor for recurrence and manage any side effects. Your care team will create a schedule that may include: 

• Physical exams and skin checks 
• Imaging tests to check for recurrence 
• Support for managing scars, swelling, or lymphedema 
• Explore our Support Services

Clinical Trials at Columbia

At Columbia, you may be eligible to participate in a clinical trial. Clinical trials give patients access to promising new therapies that are not yet widely available. These include new immunotherapies, tissue preserving surgeries, targeted treatments for specific gene mutations common in melanoma, and more effective combination therapies. 

 Your Columbia physicians, oncologists, and nurses will help you determine if there is an ongoing clinical trial that is right for you.

Palliative and Supportive Care

Supportive and palliative care helps you manage symptoms of treatment and maintain quality of life during and after melanoma treatment. Supportive care helps you feel as well as possible, so you can stay on treatment, and palliative care helps manage symptoms and relieve pain, and address emotional distress—for both patients and their families. Our support team offers: 

• Expert pain and symptom management 
• Emotional and psychological support 
• Guidance with complex medical decisions 
• Coordination of care across your treatment team 
• Nutritional support and genetic counseling 
• Integrative therapies like acupuncture or meditation 

Supportive and palliative care can be provided at any stage of melanoma treatment, not just at the end of life.

Your Treatment, Your Voice

Your treatment should reflect not just your diagnosis—but your goals, preferences, and life outside of cancer. At Columbia, we take the time to understand what matters most to you. We will help you weigh your options, involve you in every decision, and ensure your voice is part of your care plan every step of the way.