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How We Treat Melanoma

  • Our unique position

    Our Center for Melanoma Oncology is committed to world-class care and innovative research. Our 50-50 balance of research and patient care uniquely positions us to develop and deploy promising new treatments. This dual focus fosters collaboration among researchers, clinicians, and patients to help translate discoveries made in the lab to new and more effective treatment options.

    Our physician-scientists' investigations into immunotherapies and the genetic underpinnings of melanoma are paving the way for personalized medicine. We have numerous melanoma-related clinical trials currently underway, testing new immunotherapies, vaccines, and novel, targeted drugs.

    Experts from a wide variety of specialties come together to evaluate and treat your particular melanoma, no matter how simple or complex. We regularly treat patients with many forms of melanoma, including intraocular melanoma and mucosal melanoma.

    Multidisciplinary approach

    When you come to our Center, you receive care from a multidisciplinary team of doctors and other clinical providers. Working together as one singularly-focused team, our medical and surgical oncologists, radiation oncologists, dermatologic oncologists, dermatopathologists, radiologists, plastic and reconstructive surgeons, and nurses evaluate and treat your melanoma together. Because of our specialists' close integration, our team offers you their collective expertise when formulating and executing an optimal, highly coordinated care plan.

    Patients with melanoma often require a combination of surgery, chemotherapy, and radiation therapy. For this reason, our coordinated team approach is the best way to manage these complicated cases. Our team holds:

    • Weekly tumor boards to discuss patients' cases.
    • Monthly lectures to discuss the latest advances in the clinical and research aspects of melanoma.
    • Pigmented Lesion Clinics.

    We collaborate with other specialists at Dana-Farber/Brigham and Women's Cancer Center to treat patients with central nervous system, lung, liver, and other metastases.

    Personalized treatment plans

    As a highly specialized Center, we focus on the distinct needs of people with melanoma. This enables us to provide a very personalized approach to your care.

    Your team works to ensure that your care plan will offer the best possible outcomes, and that all your needs are met. We view every patient as an individual with unique needs and expectations, so we take the time to involve you and your family in each step of the treatment process. As you go through treatment and recovery, you have access to a wide range of resources – from nutritional services to integrative therapies – to support you and your family.

    Immunosuppression and Skin Cancer Clinic

    Immunosuppressed people have an elevated risk of skin cancer, a factor particularly relevant for light-skinned people who have had several sunburns in their lifetime. We specialize in the prevention and treatment of skin cancer in patients who are immunosuppressed because of certain diseases or immune-suppressing medications.

    Our Clinic provides topical or oral treatments when appropriate to slow down or reverse sun damage. With proactive treatments and monitoring, even patients who have had multiple cancers can have a marked decrease in the number of new cancers they develop.

    If you would like a second opinion, or to have our team consult on your care plan...

    It is important to be seen quickly if you've been diagnosed with melanoma so you can start treatment. We provide evaluation and diagnostic services for people who:

    • Have received a diagnosis of melanoma and want to be treated at the Center for Melanoma Oncology at Dana-Farber/Brigham and Women's Cancer Center.
    • Would like a second opinion, including referring doctors throughout the country.

    Some reasons to consider a second opinion include:

    • To confirm your diagnosis and stage of melanoma.
    • To determine the optimal therapy.
    • To learn more about your cancer from a specialist who has treated other patients like you.
    • To learn if you're eligible for a clinical trial.

    Phone: 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston, you can take advantage of our Online Second Opinion service

    Treatment for melanoma

    When you begin your treatment, you will have access to many of the world's leading melanoma specialists, who work closely together to evaluate and treat patients with confirmed or suspected melanoma. Our Center offers novel interventions, including minimally-invasive surgical approaches, adjuvant medical therapy, and advanced radiation techniques.

    The goal of treatment is to remove or destroy the cancer completely. If all of the melanoma was removed during your biopsy, you may not need any further treatment.

    Certain factors affect your treatment options

    Your prognosis (chance of recovery) and treatment options depend on:

    • The thickness of the tumor.
    • How quickly the cancer cells are dividing.
    • Whether there was ulceration at the primary site.
    • Whether cancer has spread to the lymph nodes or other places in the body.
    • The number of locations where cancer has spread in the body, and the level of lactate dehydrogenate (LDH) in your blood.
    • Whether the cancer has certain mutations (changes) in a gene called BRAF V600E.
    • Your general health.

    Treatments can include:

    Surgery

    Treatment of melanoma is considered a highly specialized field of cancer surgery. At DF/BWCC's Center for Melanoma Oncology, our surgical oncologists are among the world's leading surgical specialists treating complex and advanced-stage melanoma. And our plastic and reconstructive surgeons are pioneers in groundbreaking procedures. The size and experience of our surgical group allow us to tailor specific, individual care to each patient.

    Surgery to remove the tumor is the usual treatment of all stages of melanoma. The goal of surgery is to remove the melanoma, while leaving as much of the nearby skin as intact as possible.

    Your surgeon may perform the following procedures:

    • Wide local excision: Surgery to remove the melanoma and some of the normal tissue around it.
    • Lymphadenectomy: A surgical procedure in which all of the lymph nodes are removed from an area (for example, cervical, axillary, external iliac, or femoral).
    • Sentinel lymph node biopsy: Removal of the sentinel lymph node (the first lymph node the cancer is likely to reach) during the wide local excision. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove additional lymph nodes.

    Sentinel lymph node biopsy of the skin. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).


    If your regional cancer has spread to the lymph nodes, the surgeon may remove some or all of the nearby lymph nodes.

    Our Center is unique in that our surgical oncologists closely collaborate with plastic surgeons for reconstruction. If you have a large area of tissue to be removed, you may have reconstruction done by plastic surgeons from Brigham and Women's Hospital.

    Radiation therapy

    You will receive a carefully considered, customized plan to use radiation therapy when and where it is likely to be most effective. The goal of radiation is to destroy cancer cells. It may be used:

    • After surgery to eliminate any cancer cells that may be left.
    • To treat melanoma that has come back after initial treatment, or has spread to other parts of the body.
    • If your melanoma is located in an area that makes it hard to remove by surgery.

    We offer a range of radiation therapies for advanced melanoma.

    Radiation therapy uses high-energy X-rays to destroy cancer cells or keep them from growing:

    • External radiation therapy uses a machine outside the body to direct radiation to the cancer site or sites.
    • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

    Clinical trials

    Clinical trials available through our Center for Melanoma Oncology provide a range of treatment options, including trials for high-risk patients or patients with metastatic melanoma. Our trials include leading-edge immunotherapy, vaccines, and novel targeted therapies to treat Stage III and IV melanoma.

    Our specialists are actively involved in research and apply the latest knowledge to your care. Our many targeted therapies through clinical trials are a significant part of our treatment approach and provide you with the most innovative treatment options, which may not be available elsewhere.

    Immunotherapy

    Immunotherapy is a treatment that uses the body's own immune system to fight against cancer cells. Some immunotherapy treatments aim to boost the immune system defenses in a general way; others help train the immune system to recognize and attack the cancer cells. This kind of therapy may also help to mitigate the side effects of other treatments.

    • Our physician-scientists are leaders of clinical trials that have shown the effectiveness of ipilimumab, the first in a new class of immunotherapy drugs that are helping some patients with advanced melanoma survive 10 years or longer.
    • Our researchers have revealed striking results of an immune system-based therapy drug called nivolumab for patients with metastatic melanoma, achieving a three-year survival rate of 41 percent.
    • Our researchers found that treating advanced melanoma patients initially with the combination of the immunotherapy drugs nivolumab and ipilimumab achieves a much higher response rate than treatment with ipilimumab alone.
    • Our research has played a key role in clinical trials leading to FDA approval of the combination of ipilimumab and nivolumab, which is used as a standard treatment for advanced melanoma.
    • Oncolytic virus therapy uses a virus that infects and breaks down cancer cells without impacting healthy cells. This treatment is now approved for patients with advanced melanoma.
    • Our researchers have discovered that a promising experimental drug known as MPDL3280A works best in patients whose immune defenses initially rally to attack the cancer but are then stopped by a molecular process that shuts down the immune response.
    • Interferon and interleukin-2 are also types of immunotherapy used to treat melanoma.

    Learn how the Center for Immuno-Oncology helps investigators take advantage of the latest advances in immunotherapy.

    Targeted therapies

    Targeted therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs," "molecularly targeted therapies," or "precision medicines."

    More and more, targeted therapies focus on specific molecular changes, such as mutations in BRAF, NRAS, or c-kit, in a patient's individual tumor. Dana-Farber/Brigham and Women's Cancer Center is a leader in precision cancer medicine (also called personalized medicine). As a patient, your tumor will be tested for genetic mutations. This testing may help to guide your care using standard treatments, or direct you to the right clinical trials of highly effective therapies based on your tumor's characteristics.

    Types of targeted therapies include:

    • Signal transduction inhibitor therapy: This blocks signals passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells.
      • Vemurafenib, dabrafenib, trametinib, and cobimetinib are signal transduction inhibitors that are approved by the FDA to treat advanced melanoma that carries a certain mutation, called a BRAF V600 mutation, which is present in about half of melanomas.
       
    • Angiogenesis inhibitors: This treatment focuses on the blood supply to tumors. These therapies stop the development of new blood vessels that tumors need to grow and spread.

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either eliminating the cells or stopping them from dividing. You may receive chemotherapy by mouth or through a vein (infusion). With immunotherapy and targeted therapy now available for melanoma that cannot be removed by surgery, chemotherapy plays a less important role in treatment.

    Sometimes, if the melanoma is on your arm or leg, you may receive chemotherapy treatment through an IV injected directly into that limb (isolated limb perfusion). If necessary, the infusion can be given more than once.

    While undergoing chemotherapy at Dana-Farber/Brigham and Women's Cancer Center, your medical oncologist and nurse will be closely monitoring your care. Our medical oncologists have experience with the latest therapies, as well as the expertise to tailor these therapies to you for the best possible outcome.

    • Throughout your treatment, our team of medical oncologists, nurse practitioners, nurses, dietitians, social workers, and other staff will work to minimize the side effects of chemotherapy, and maximize your quality of life.
    • Our team will coordinate your care with additional specialists who will address any other symptoms you may be experiencing, such as emotional distress.

    Topical therapies

    In specific cases when the tumor is confined only to the skin and surgery is not an option, topical therapies that destroy melanoma cells or boost immunity in an area may be used to remove melanoma cells.

    Treatment by stage

    Treatment options may include the following:

    Stage 0 (melanoma in situ):

    Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.

    Stage I:
    • Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and removal of lymph nodes are also done.
    • A clinical trial of new ways to find cancer cells in the lymph nodes.
    Stage II:
    • Surgery to remove the tumor and some of the normal tissue around it.
    • Lymph node mapping and sentinel lymph node biopsy, followed by surgery to remove the tumor and some of the normal tissue around it. If cancer is present in the sentinel lymph node, a second surgery may be performed to remove additional nearby lymph nodes.
    • A clinical trial of a new type of treatment after surgery.
    Stage III:

    If surgery is an option:

    • Surgery to remove the tumor and some of the normal tissue around it. Surgery followed by immunotherapy with interferon if there is a high risk that the cancer will recur (come back).
    • A clinical trial for a new type of adjuvant therapy.

    If surgery is not an option:

    • Immunotherapy with nivolumab, combined nivolumab plus ipilimumab, or ipilimumab.
    • Targeted therapy with dabrafenib plus trametinib or vemurafenib plus cobimetinib.
    • Treatment with the oncolytic virus talimogen laherparepvec.
    • Regional chemotherapy.
    • Some patients may also have immunotherapy with tumor necrosis factor.
    Stage IV and recurrent melanoma:
    • Immunotherapy with nivolumab, combined nivolumab plus ipilimumab, or ipilimumab.
    • Targeted therapy with dabrafenib plus trametinib, or vemurafenib plus cobimetinib.
    • Treatment with the oncolytic virus talimogen laherparepvec.
    • Immunotherapy with interleukin-2 (IL-2).
    • Chemotherapy.
    • Palliative therapy to relieve symptoms and improve quality of life.

    Supportive resources

    While many melanomas can be removed easily, you may want support to address your symptoms, and to help with any side effects of treatment. To address all your physical and emotional needs, we encourage you and your family to explore our comprehensive range of support services and integrative therapies.

    Recurrent melanoma

    While many new treatments are effective, melanoma can return in the area where it first started or in other parts of the body, such as the lungs or liver. Our physician-scientists are studying ways to reduce the risk of recurrence.

    Your hospital care

    Post-surgical and other inpatient care are provided by the Dana-Farber/Brigham and Women's Cancer Center team either at Brigham and Women's Hospital or at Dana-Farber's Inpatient Hospital located within Brigham and Women's Hospital.

    All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

    Radiation Oncology has two separate units, one at Brigham and Women's Hospital and the other at Dana-Farber.

    For referring physicians

    Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

    If you are a physician and have a patient with diagnosed or suspected melanoma, we look forward to working with you. How to refer a patient.

    Melanoma Support Services and Follow-Up Care

    At the Center for Melanoma Oncology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), we understand that a melanoma diagnosis and treatment can be challenging for your whole family. To address all of your and your family's needs, we provide a comprehensive range of support services and integrative therapies.

    We offer individual and family counseling, nutritional counseling, exercise planning, rehabilitation and physical therapy, pain and symptom management, acupuncture, massage, Reiki, and support groups. You have access to all of the many resources available at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) throughout your treatment and recovery.

    • You may wish to join a specialized support group for patients with skin cancer.
    • Our licensed social workers are here to help you and your loved ones face the many new concerns following a cancer diagnosis, offering emotional support and practical assistance.
    • Friends' Place provides personal consultations to help cancer patients of all ages cope with changes in physical appearance that may result from cancer treatment.
    • Our resources for caregivers help family members and other caregivers with practical tips and suggestions, including creating a caregiving plan, finding community resources, and looking after their own well-being.
    • Our Patient and Family Resource Centers are staffed by health care professionals and provide computer stations, books, brochures, videos, and CDs on a wide spectrum of information about cancer treatment and care.

    Survivorship care

    We follow our patients very closely after treatment, and you will need to be seen regularly for the first few years so we can monitor your health and treat any new growths right away. You may have X-rays, blood tests, and scans of your chest, liver, bones, and brain.

    Follow-up care is important because if you have had melanoma, you have an increased risk of developing a new melanoma.

    Our Adult Survivorship Program helps you find expertise, education, and support to manage issues related to surviving cancer.

    Explore additional information, resources, and support for living well beyond cancer.