Melanoma treatment depends on how deep the cancer has grown and whether it has spread, but surgery is the foundation for nearly every case. When caught early and still confined to the skin, the five-year survival rate is effectively 100%. Even advanced melanoma now has far more treatment options than it did a decade ago, with immunotherapy and targeted drugs dramatically improving outcomes.
Surgery: The First Step for Most Melanomas
The primary treatment for melanoma is a procedure called wide local excision, where a surgeon removes the melanoma along with a margin of healthy skin around it. The size of that margin depends on the tumor’s thickness, measured in millimeters using a scale called Breslow depth:
- Melanoma in situ (hasn’t grown beyond the top layer of skin): 0.5 to 1 cm margin
- Up to 1 mm thick: 1 cm margin
- 1 to 2 mm thick: 1 to 2 cm margin
- Thicker than 2 mm: 2 cm margin
For thin, early melanomas, this surgery is often the only treatment needed. The procedure is typically done under local anesthesia, and most people go home the same day. Stitches close the wound, and healing takes a few weeks depending on the location and size of the excision.
Checking the Lymph Nodes
When melanoma grows thicker, there’s a higher chance it has sent cancer cells to nearby lymph nodes. A sentinel lymph node biopsy helps determine whether that’s happened. During this procedure, a surgeon removes the first lymph node (or nodes) that drain from the tumor site and checks them for cancer cells.
This biopsy is recommended when the melanoma is between 1 and 4 mm thick. For thinner melanomas (0.8 to 1 mm, or thinner ones that show ulceration), it may be offered after a discussion about the risks and benefits. Very thin, non-ulcerated melanomas under 0.8 mm rarely spread, so routine biopsy isn’t recommended for those. For very thick melanomas over 4 mm, the decision is individualized.
If cancer is found in the sentinel node, your treatment plan will expand to include additional therapies. If the nodes are clear, that’s a strong reassuring sign and influences the follow-up schedule going forward.
Immunotherapy for Advanced Melanoma
Immunotherapy has transformed melanoma treatment over the past decade. These drugs work by removing the brakes that cancer puts on your immune system, allowing your body’s own defenses to recognize and attack melanoma cells.
The most commonly used immunotherapy drugs for melanoma are checkpoint inhibitors, which target specific proteins that tumors exploit to hide from immune cells. There are several approaches now available:
- PD-1 inhibitors (pembrolizumab, nivolumab) block a protein that melanoma uses to evade immune detection. These are often the backbone of treatment for advanced melanoma.
- Dual checkpoint inhibition combines a PD-1 inhibitor with a CTLA-4 inhibitor (ipilimumab), hitting two immune checkpoints at once. This combination has shown longer survival compared with single-agent treatment, though it also carries more side effects.
- LAG-3 plus PD-1 inhibition pairs nivolumab with relatlimab, a newer type of checkpoint inhibitor. This combination slows disease progression compared with nivolumab alone and is now approved as a first-line option for advanced melanoma.
Side effects from immunotherapy happen because an unleashed immune system can sometimes attack healthy tissues too. Common issues include fatigue, skin rashes, and inflammation in organs like the thyroid, liver, or intestines. Your care team monitors for these closely, and most are manageable when caught early. The dual checkpoint combination tends to produce more frequent and more intense side effects than single-agent therapy.
Targeted Therapy for BRAF-Mutant Melanoma
About half of all melanomas carry a mutation in a gene called BRAF, which drives cancer growth through a specific signaling pathway. If your melanoma tests positive for this mutation, you may be a candidate for targeted therapy: oral pills that block the faulty signaling directly.
Treatment pairs a BRAF inhibitor with a MEK inhibitor, because combining the two works better than either alone and helps prevent the cancer from developing resistance. Three approved combinations exist: dabrafenib with trametinib, vemurafenib with cobimetinib, and encorafenib with binimetinib. All are taken as daily pills.
Targeted therapy tends to shrink tumors quickly, often within weeks. That rapid response can be especially valuable when melanoma is causing symptoms that need fast relief. Side effects differ from immunotherapy and commonly include fever, joint pain, fatigue, and skin changes. Some people develop new non-melanoma skin growths that need monitoring.
For people with stage III melanoma (spread to nearby lymph nodes) who have had surgery to remove it, targeted therapy with dabrafenib and trametinib can also be used afterward to reduce the chance of the cancer returning.
Treatment Before Surgery: The Neoadjuvant Approach
An increasingly important strategy for melanoma that has spread to lymph nodes but can still be surgically removed is giving immunotherapy before surgery, not just after. This approach, called neoadjuvant therapy, lets the immune system attack the tumor while it’s still in the body, which appears to prime a stronger and more lasting immune response.
A large meta-analysis published in The Lancet found that patients who received immunotherapy before surgery had a 42% lower risk of disease progression and a 36% lower risk of death compared with those who received treatment only after surgery. Importantly, the rate of serious side effects was not significantly higher with the pre-surgery approach. This strategy is becoming standard for many patients with resectable stage III melanoma.
Treating Metastatic Melanoma
When melanoma spreads to distant organs like the lungs, liver, brain, or bones, it’s classified as stage IV. The five-year survival rate at this stage is 34%, a number that has improved substantially thanks to modern therapies. Treatment focuses on systemic therapy, meaning drugs that reach cancer throughout the body.
First-line treatment is typically either immunotherapy (checkpoint inhibitors) or, for BRAF-mutant tumors, targeted therapy. The choice depends on factors like mutation status, how quickly the cancer is growing, where it has spread, and your overall health. Both approaches have demonstrated improved survival in large clinical trials. Because new drug combinations continue to emerge, clinical trials are a reasonable option to consider at any point during treatment.
For isolated metastases, surgery or radiation may still play a role alongside systemic treatment. Brain metastases, which melanoma has a particular tendency to cause, can be treated with focused radiation or, in some cases, surgical removal.
Survival Rates by Stage
Five-year relative survival rates from the SEER database (based on 2016 to 2022 data) give a broad picture of outcomes:
- Localized (confined to the skin): 100%
- Regional (spread to nearby lymph nodes): 76%
- Distant (metastasized to other organs): 34%
These numbers reflect averages across all patients in each category. Individual outcomes vary based on specific tumor features, treatment response, and overall health. The distant-stage survival rate in particular has climbed sharply since immunotherapy and targeted therapy became available.
Follow-Up After Treatment
Melanoma can recur years after initial treatment, so long-term monitoring is part of the plan regardless of stage. The schedule is more intensive for higher-stage disease and gradually spaces out over time.
For stage 0 (melanoma in situ), a full-body skin exam once a year for life is the standard recommendation. Stage I and IIA melanomas call for a physical exam every six to twelve months for the first five years, then annually. Stages IIB, IIC, and III require closer monitoring: every three to six months for the first two years, then every three to twelve months for the next three years, tapering to yearly visits afterward. Stage IV melanoma that has been completely removed is followed with physical exams, bloodwork, and imaging scans every three to six months for at least the first two years.
Beyond scheduled appointments, you should perform your own monthly skin checks. Look for new or changing moles, spots that don’t heal, and any lumps under the skin near the original site or in lymph node areas. People who have had one melanoma are at higher risk of developing a second one, making lifelong skin awareness essential.