Treatments for metastatic melanoma skin cancer

Metastatic melanoma skin cancer means that the cancer has spread to or come back in different parts of the body than where it started. This includes stage 4 melanoma and distant recurrences.

The following are treatment options for metastatic melanoma. They may also be used for locoregional melanoma if it can't be removed with surgery (is unresectable). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy for metastatic melanoma. It is used to help shrink and control the growth of the melanoma. The immunotherapy drugs used include:

• nivolumab (Opdivo)
• pembrolizumab (Keytruda)
• nivolumab and relatlimab (Opdualag)
• ipilimumab (Yervoy)

These drugs are given through a needle into a vein by infusion. How often and how long immunotherapy is given depends on the type of drug used. Immunotherapy drugs may be used alone or ipilimumab may be combined with nivolumab.

You may be offered localized therapy to treat cancer that has spread to nearby areas of skin (called satellite tumours) or to lymph vessels (called in-transit metastasis) and that can't be removed by surgery. This means that the immunotherapy treatment is given directly into or put on the surface of the tumours.

Aldesleukin (Proleukin or interleukin-2, IL-2) is the most common immunotherapy drug used for localized therapy. It is injected directly into a tumour (called intralesional treatment).

Imiquimod (Aldara, Zyclara) may be used with aldesleukin. Imiquimod is a cream that is applied directly to the skin.

Topical diphenylcyclopropenone (DPCP) is an immunotherapy drug that is applied to the skin as a cream.

Find out more about immunotherapy for melanoma skin cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Targeted therapy is usually offered for unresectable locoregional or metastatic melanoma with certain gene changes (mutations), including mutations in the BRAF gene.

The targeted therapy drugs used to treat metastatic melanoma include:

• dabrafenib (Tafinlar) combined with trametinib (Mekinist)
• vemurafenib (Zelboraf) combined with cobimetinib (Cotellic)
• encorafenib (Braftovi) combined with binimetinib (Mektovi)

Imatinib (Gleevec) may be offered for metastatic melanoma with a C-KIT gene mutation.

Targeted therapy drugs are taken as a pill by mouth (orally) daily. How long treatment is given depends on the type of drug used and how well the cancer responds to the treatment.

Find out more about targeted therapy for melanoma skin cancer.

Surgery is rarely used to treat metastatic melanoma. You may be offered surgery if cancer is only in:

• 1 or a few small areas on or just under the skin
• 1 group of lymph nodes
• a lung, the liver, the brain or the small intestine

The type of surgery done will depend on where cancer has spread.

Find out more about surgery for melanoma skin cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy for metastatic melanoma. It is also used as a palliative treatment to control symptoms from metastases.

External radiation therapy is aimed at the area where melanoma has spread, such as the skin, lymph nodes, bone, brain, lung, liver or pelvis.

Stereotactic radiation therapy is a type of external radiation therapy. It may be used when small areas of cancer are found and need to be treated. It delivers a high dose of radiation to a very specific area of the body.

How long radiation therapy is used depends on the number and size of metastases, the type and dose of radiation therapy used, how severe symptoms are and other factors.

Find out more about radiation therapy for melanoma skin cancer.

Chemotherapy uses drugs to destroy cancer cells. It may be offered to control symptoms of metastatic melanoma (called palliative chemotherapy). It may also be used to treat metastatic melanoma if other treatments haven't worked.

The chemotherapy drugs most commonly used for metastatic melanoma are:

• dacarbazine
• carboplatin and paclitaxel

These drugs are given through a needle into a vein (intravenously).

Find out more about chemotherapy 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.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.