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Melanoma

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Treatment of recurrent melanoma

The following are treatment options for recurrent melanoma. Melanoma may recur in the same location as the original cancer (local recurrence) or it may recur in another part of the body (metastatic melanoma).

Local recurrence can occur in the original site of the melanoma, such as in the scar from the excision. A recurrence may also occur as a satellite (metastasis found within 2 cm of the original site or scar) or in-transit metastasis (skin or subcutaneous tissue involvement more than 2 cm from the original site or scar).

The types of treatments given are based on the unique needs of the person with cancer.

Surgery

Surgery may be used to treat recurrent melanoma.

  • Re-excision may be used to remove melanoma that has recurred in the original site or excision scar.
  • Surgery may be used to remove melanoma that has recurred in the skin (as a satellite or in-transit metastasis) or lymph nodes. If the disease is unresectable, treatment with isolated limb perfusion or infusion may be considered.
  • Surgery may be used to remove a tumour in the brain, liver, lung, bowel, subcutaneous tissue or pancreas when there is no other metastasis. People being considered for surgery to remove a single metastasis to the brain, liver or lung must be thoroughly investigated with computed tomography (CT) or magnetic resonance imaging (MRI) and positron emission tomography (PET) to ensure that there is no other metastasis.

Chemotherapy

Chemotherapy may be used to treat recurrent melanoma that cannot be removed with surgery (unresectable). While it cannot cure the cancer, chemotherapy can be used to control the growth and spread of the cancer. It may also help to extend life and relieve symptoms (palliative chemotherapy) of advanced disease. The most common types of chemotherapy used are:

  • dacarbazine (DTIC)
  • temozolomide (Temodal)
    • used for malignant melanoma with brain metastasis

Regional chemotherapy

Regional chemotherapy may be used to treat people with local nodal metastases, in-transit metastases or multiple recurrences on an arm or leg that cannot be removed with surgery. The chemotherapy drug most commonly used for regional chemotherapy is melphalan (Alkeran, L-PAM).

Regional chemotherapy may involve:

  • isolated limb perfusion
  • isolated limb infusion

Targeted therapy

Targeted therapy may be offered to people with unresectable metastatic melanoma. Most of these drugs are given by mouth. The targeted chemotherapy drugs used to treat advanced or metastatic melanoma are:

  • vemurafenib (Zelboraf)
  • dabrafenib (Tafinlar)
  • trametinib (Mekinist)
  • pembrolizumab (Ketyruda) – given by intravenous (IV)intravenous (IV)Within or into a vein (a blood vessel that carries blood from tissues and organs in the body to the heart). infusion

Biological therapy

Biological therapy may be offered to people with unresectable metastatic melanoma. Biological therapies that may be used include:

  • intralesional Bacillus Calmette-Guérin (BCG)
    • BCG may be used for local or regional metastasis. It is injected into the tumour directly and is less toxic than systemic therapies
  • interleukin-2 (Aldesleukin, Proleukin)
    • Interleukin-2 may be used to treat local recurrences on an arm or a leg. It is injected into individual lesions. This method has fewer side effects than regional chemotherapy and does not need to be done in a specialized centre.
    • Interleukin-2 may be used systemically (by intravenous (IV) infusion) to treat advanced melanoma.
  • ipilimumab (Yervoy)
    • Ipilimumab is a monoclonal antibody used to treat advanced or metastatic melanoma. It is given by IV infusion.

Radiation therapy

External beam radiation therapy may be used to treat melanoma that recurs in either the skin or lymph nodes after surgery. It may also be used to treat distant spread and control symptoms of advanced cancer. Stereotactic radiation therapy may be used for a single unresectable brain metastasis.

Clinical trials

People with melanoma may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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