The following are treatment options for stage IV melanoma. The types of treatments given are based on the unique needs of the person with cancer. The goals of treatment for stage IV melanoma are to shrink and control any metastases and to relieve symptoms. Treatment for people with metastatic melanoma that cannot be removed by surgery (unresectable) is often recommended through participation in clinical trials.
Surgery may be used to treat stage IV melanoma.
- Certain people may benefit from surgery for distant metastatic melanoma.
- Surgery may be used to remove extensive skin and soft tissue metastasis when there is no other metastasis.
- Surgery may be used to remove a single metastasis in the brain, liver or lungs when there is no other metastasis. People being considered for surgery to remove 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.
- Surgery may be used in some cases as palliative therapy to remove metastatic melanoma and to relieve symptoms, such as:
- anemia caused by bleeding of gastrointestinal metastasis
- bowel obstruction caused by bowel metastasis
- ulceration or pain caused by skin or soft tissue metastasis
- neurological symptoms caused by lymph node metastasis
Chemotherapy may be used to treat stage IV melanoma. 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)
- lomustine (CeeNU, CCNU)
- temozolomide (Temodal)
- used for malignant melanoma with brain metastasis
Targeted therapy may be offered to people with unresectable metastatic melanoma. These drugs are given by mouth. The targeted chemotherapy drugs used to treat advanced or metastatic melanoma are:
- vemurafenib (Zelboraf)
- dabrafenib (Tafinlar)
- trametinib (Mekinist)
- prembolizumab (Keytruda)
Biological therapy may be offered to people with metastatic melanoma. Biological therapies are usually 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 and include:
- ipilimumab (Yervoy)
- interleukin-2 (Aldesleukin, Proleukin)
- interferon-alfa-2b (Intron A)
External beam radiation therapy may be used to treat metastatic disease and control symptoms of advanced cancer. Stereotactic radiation therapy may be used for a single unresectable brain metastasis.
People with melanoma may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.