Treatments for early-stage melanoma skin cancer

Early-stage melanoma skin cancer is only in the skin and hasn't spread to the lymph nodes. It includes stage 0 (melanoma in situ), stage 1 and stage 2.

The following are treatment options for early-stage melanoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the standard treatment for early-stage melanoma. It's often the only treatment needed.

A wide local excision (sometimes called surgical resection) removes the tumour and a small amount of healthy tissue around it (called the surgical margin). The size and depth of the surgical margin depends on how thick the tumour is and where it is on the body.

A sentinel lymph node biopsy (SLNB) may be offered for early-stage melanoma. An SLNB finds and removes the first lymph node (or first few lymph nodes) in a group of lymph nodes to see if it contains cancer cells. An SLNB may be done if the melanoma is more than 1 mm thick. Doctors may also consider doing an SLNB for slightly thinner tumours (0.8 mm to 1 mm thick) or very thin tumours (less than 0.8 mm thick) if they have high-risk features. High-risk features include if the skin over the tumour is broken with an open wound (called ulceration) or if the cancer cells are dividing rapidly (called a high mitotic rate). If cancer is found in the lymph nodes, it is restaged as a stage 3 melanoma. Find out more about treatments for locoregional melanoma skin cancer.

A skin graft is when the surgeon removes skin from another area of the body and places it over the surgical area to cover the open wound and repair the skin. If the surgical wound is small, the surgeon may rotate a nearby piece of skin to cover the open wound.

Find out more about surgery for melanoma skin cancer.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy after surgery for early-stage melanoma to reduce the risk of the cancer coming back (recurring).

Pembrolizumab (Keytruda) may be used for stage 2B and stage 2C. It is given through a needle into a vein (intravenous infusion) once every 3 or 6 weeks for 1 year.

Nivolumab (Opdivo) may also be used for stage 2B and stage 2C. It is given through a needle into a vein.

Find out more about immunotherapy for melanoma skin cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be offered after surgery for certain cases of early-stage melanoma or if surgery is not possible. It can also be used if:

• there is a high risk that the cancer will come back in the same area where it was removed (local recurrence)
• cancer cells are found in the tissues around the tumour that were removed during surgery (called a positive surgical margin) and more surgery is not possible

External radiation therapy is aimed at the area of skin where the cancer was removed. It is usually given daily for several weeks.

Find out more about radiation therapy for melanoma skin cancer.

Talk to your doctor about clinical trials open to people with melanoma in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.