Surgery is the most common melanoma treatment and provides the best chance for cure of early stage disease. Our doctors can complete most procedures under local anesthesia in the outpatient (office) setting). The goal is to remove the lesion and a small section of healthy tissue (margin) to reduce the cancer’s chance of returning.  

Types of surgery for melanoma skin cancer include:

• Excisional surgery: Your doctor cuts out the tumor plus a margin of normal skin around it and closes the wound. We send the tumor to a lab where a dermatopathologist examines it under a microscope to ensure the procedure removed the cancer.
• Mohs micrographic surgery: This advanced surgical technique removes melanoma while sparing healthy tissue around the tumor; it is used for early stage melanomas including melanoma in situ and stage I disease, typically on the face, scalp, or ears. The procedure is done as an outpatient surgery under local anesthesia. Your dermatology surgeon removes a layer of tissue, and immediately examines it under a microscope to check for cancer cells. Your doctors repeat this procedure on the same area of skin until no cancer cells remain.
• Sentinel lymph node biopsy: Your doctor may identify and remove the lymph node to which cancer is most likely to spread (the sentinel lymph node) to determine the melanoma stage. This procedure is performed by a surgical oncologist and involves mapping of the skin melanoma to the nearby lymph nodes to remove the initial draining node(s). The dermatopathologist looks for cancer cells in the sentinel lymph node to determine if additional therapy is needed after surgery (called adjuvant therapy).
• Lymph node dissection: If melanoma has spread to one or more lymph nodes, your doctor may remove several or all lymph nodes in that area to prevent additional spreading. Indications for lymph node dissection, either after a positive sentinel lymph node biopsy or if the lymph nodes are enlarged, have changed, due to better systemic drug therapies for melanoma.

Cancer drugs destroy cancer cells or help your body fight them. You may take medications while receiving other skin cancer treatments. Drugs may include:

• Topical medications: Your doctor may recommend an immunotherapy skin cream to treat melanoma in situ, which is confined to the skin’s surface (epidermis), usually when surgery isn’t possible. Different skin creams can also help alleviate skin infections or rashes that may occur during treatment.
• Immunotherapy: These medications fight cancer by either stimulating the immune system or targeting specific molecules on cancer cells. Immunotherapies using immune checkpoint inhibitors are the mainstay of treating advanced melanoma (stages 3 and 4). They have been associated with long-term responses and cures in about 50% of people.
• Targeted therapy: These medications can target certain gene mutations on cancer cells to block their growth without harming nearby tissues.
• Chemotherapy: These medications shrink or destroy cancerous cells but are now seldom used for active melanoma therapy. Chemotherapy has been replaced by immunotherapy and targeted therapy for people with advanced melanoma.

Radiation therapy is a painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue. Radiation therapy has a limited role in treating melanoma of the skin or nearby lymph nodes. It is more commonly used to treat distant sites of metastasis, including brain metastasis.

Our team is skilled at treating melanoma with several types of radiation therapy, including:

• 3D conformal radiation therapy (3D-CRT): With this method, 3D images help the doctor better target the tumor. We create the images using a computed tomography (CT) or magnetic resonance imaging (MRI) machine. Your doctor can aim the radiation beams from many angles to match the exact shape of the cancer.
• Intensity-modulated radiation therapy (IMRT): IMRT is similar to 3D-CRT, but your doctor can adjust how much radiation you get from each beam. In certain situations, this adjustment enables the doctor to avoid nearby healthy cells, reducing the risk of side effects.
• Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR): This type of radiation therapy works like the first two methods. The total amount of radiation you get is similar, yet you receive radiation in fewer but stronger doses.