UT Southwestern offers a number of advanced therapies that have helped many people with melanoma – even metastatic melanoma – live well for years after their initial diagnosis. These treatments include surgery, radiation therapy, immunotherapy, targeted therapies, and other options.
Surgery
Surgery is usually the first line of treatment for melanoma, and it might be followed by other therapies.
The incision and scar size, patient recovery time, and whether the surgery is performed as an inpatient or outpatient procedure all depend upon the melanoma’s size, depth, and location.
UT Southwestern offers melanoma surgeries that include:
- Mohs surgery: Used most often in non-melanoma skin cancers, this outpatient procedure removes skin cancer one layer at a time and can be used as an alternative to wide excision surgery.
- Traditional tumor excision: Called wide excision, this surgery involves removal of the tumor and a bit of normal surrounding tissue to check for melanoma cells. For very early, thin melanomas, this typically means a one-centimeter margin of surrounding tissue. For thicker, more advanced melanomas, a two-centimeter margin of surrounding tissue is usually necessary.
- Sentinel lymph-node biopsy: This biopsy of the adjacent lymph nodes is often performed during tumor excision surgery to see if the cancer has spread. Your surgeon will determine if you need this.
- Regional lymph-node dissection: If the cancer has spread to the lymph nodes near the cancerous area, your surgeon might need to remove a large number of nodes and examine them for the presence of melanoma. As each layer is removed, it’s examined under a microscope. If the margins are cancer free, the surgery is completed. This process allows surgeons to spare as much tissue as possible.
- Reconstructive surgery: UT Southwestern surgeons can sometimes use reconstructive surgery to prevent or treat scarring or disfigurement after skin cancer treatment, especially when a tumor is large. We also offer immediate local tissue reconstruction after Mohs surgery.
Radiation Therapy
Radiation therapy uses external radiation – delivered by beams of high-energy X-rays – to target and destroy melanoma cells or prevent them from growing.
UT Southwestern offers both traditional radiation therapy and stereotactic radiosurgery to treat melanoma that has spread to the brain or other organs that can’t be treated with surgery or when a patient isn’t healthy enough for surgery. It might also be used after surgery to kill parts of the tumor left behind.
Our stereotactic radiosurgery tools include the Gamma Knife, which uses beams of highly focused gamma rays from hundreds of different angles that converge at the tumor, and the CyberKnife, a linear accelerator mounted on a robotic arm that moves around the head to focus multiple beams of radiation into the tumor.
UT Southwestern physicians and physicists are recognized as worldwide leaders in these sophisticated treatments.
Immunotherapy
Also known as biologic therapies, immunotherapies are state-of-the-art treatments that stimulate the body’s immune system to target and kill melanoma cells. Studies have shown that immunotherapy can be effective in treating melanoma and improve survival rates for many patients.
UT Southwestern offers several types of immunotherapy drugs, both within and outside of clinical trials, including:
Immune checkpoint inhibitor therapy: T cells, a type of white blood cell, are part of the immune system. When a T cell encounters an abnormal cell, it seeks to destroy it, while leaving normal cells alone.
A checkpoint is when a T cell “decides” whether another cell is abnormal. Melanoma cells can fool T cells into “thinking” they are normal, and as a result, the immune system doesn’t fight them.
Immune checkpoint inhibitor therapy seeks to block melanoma cells from turning off the T cells, which helps the T cells to better kill the cancer.
UT Southwestern offers CTLA-4 inhibitors such as ipilimumab, as well as PD-1 inhibitors that include pembrolizumab and nivolumab.
Patients, who receive the drugs intravenously, must be closely monitored for side effects by their physicians. It can take from six to 12 weeks for checkpoint inhibitor therapies to take effect.
Oncolytic virus therapy: This type of immunotherapy involves injecting the melanoma cells with a virus. The virus destroys the cancer cells by replicating itself within them until the cells die while leaving noncancerous cells alone.
UT Southwestern offers Talimogene laherparepvec – a modified live herpes virus also called T-Vec and Imlygic – to treat melanoma.
Targeted Therapies
Targeted therapies are drugs that target and destroy abnormal characteristics of melanoma cells without harming noncancerous cells.
UT Southwestern offers several targeted therapies, both within and outside of clinical trials. These include:
- Signal transduction inhibitor therapy: Agents that include vemurafenib, dabrafenib, trametinib, and cobimetinib block certain signals passed between molecules within cells. Disrupting these signals can prevent mutant genes such as the BRAF gene from functioning and melanoma cells from surviving and growing. A mutant BRAF gene is present in approximately half the patients with advanced melanoma.
Additional Therapies
- Chemotherapy: Chemotherapy uses drugs to kill melanoma cells or hinder their growth. It might be recommended in some advanced cases of melanoma and/or to alleviate symptoms.
- Interleukin-2 (IL-2): This immunotherapy might be used in patients with advanced and metastatic melanoma.
