Treatment for melanoma
Your specialist is part of a team of health professionals who work with you to decide on the best treatment. This team is called the multidisciplinary team (MDT).
There are 2 levels of MDT for melanoma and other skin cancers. These are the:
Local Hospital Skin Cancer Multidisciplinary Team (LSMDT)
Specialist Skin Cancer Multidisciplinary team (SSMDT)
LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer or plastic surgery centres. Everyone with suspected melanoma will see a member of one of these teams.
The treatment you have depends on:
where the cancer is
how thick the melanoma is and if it has spread (the stage)
if there are any changes in the cancer's
your general health and level of fitness
Surgery is the main treatment for melanoma in situ (Stage 0) and early melanomas. These are normally stage 1 and 2 melanomas. This means that it hasn't spread away from the original (primary) cancer.
Other treatments for early melanoma include an cream called imiquimod.
Stage 3 (regional melanoma) and stage 4 (advanced melanoma) means it has spread away from the original (primary) cancer. Treatments might include one or more of the following:
surgery
immunotherapy
to the areas where the melanoma has spread to, such as the bone or brain
injecting treatment directly into the melanoma (intralesional therapy), for example talimogene laherparepvec (T-VEC)
directly into the leg or arm where the melanoma is. This can be either isolated limb infusion or isolated limb perfusion
chemotherapy combined with an electric current (electrochemotherapy)
chemotherapy into your bloodstream (intravenous)
imiquimod cream
Find out more about the stages of melanoma skin cancer
The treatments for melanoma in situ are surgery and the immunotherapy cream imiquimod.
Find out more about melanoma in situ
Surgery is the main treatment for stage 0 melanoma. Your doctor removes an area of healthy tissue around where the melanoma was. The operation is called a wide local excision.
If your doctor is sure they removed enough tissue, this is all the treatment you need.
Read more about surgery to remove melanoma skin cancer
Surgery can cause scarring and some people may not be well enough to have an operation. Instead of surgery, you might have treatment with a cream called imiquimod. You put imiquimod on the affected area over a number of weeks. Your doctor, nurse or pharmacist will tell you how long you use it for.
You might have another skin biopsy after you have had imiquimod treatment to see if it has worked.
Read more about imiquimod cream
Stage 1 and 2 melanomas are early cancers. The cancer is only in the skin and hasn’t spread to the or other parts of the body.
A wide local excision is the main treatment. For stage 1A melanoma this is usually all the treatment you need.
Your doctor might offer you treatment after surgery if you have stage 2B or 2C melanoma. This is called adjuvant treatment. The aim is to reduce the risk of the cancer coming back.
You might have targeted cancer drugs or immunotherapy for a year.
Your doctor might offer you a lymph node test for:
stage 1B melanoma
stage 2 melanoma
some stage 1A melanomas
This test is called a sentinel lymph node biopsy (SLNB). It is to check the lymph nodes for melanoma cells.
You usually have it at the same time you have a wide local excision. Knowing if there are cancer cells in your lymph nodes, helps your doctor decide on the best treatment.
Read more about having a sentinel lymph node biopsy
Most people with melanomas less than 1mm thick don't have cancer cells in the nearby lymph nodes. If your doctor does find them the melanoma is stage 3.
Read more about stage 3 melanoma skin cancer
Some people may decide not to have the test. They normally have regular ultrasounds of their lymph nodes instead. This is called surveillance. But the service may not be available at all hospitals. Ultrasound surveillance is usually for 5 years.
You may need a biopsy if the scans show there may be melanoma cells in your lymph nodes. You may also need a biopsy if your lymph nodes become swollen. Your doctor will take some cells from the lymph nodes using a needle. This is different to a sentinel lymph node biopsy.
Read more about have an ultrasound and lymph node biopsy
Stage 3 means that cancer cells have spread to either:
an area between the melanoma and the nearby lymph nodes
the lymph nodes near the melanoma
Melanoma can spread to the area between the primary cancer and the nearby lymph nodes. These are called micro satellite, satellite or in-transit metastases. Which ones they are depend on how far away the cancer cells are from the melanoma.
Surgery is the main treatment for stage 3 melanoma. In Scotland, some people may be able to have immunotherapy before surgery. Doctors call this .
If you can’t have surgery, you might have one of the following:
an injection directly into the melanoma (intralesional therapy). This is normally a cancer drug called talimogene laherparepvec (T-VEC)
chemotherapy combined with an electric current (electrochemotherapy)
chemotherapy directly into the leg or arm where the melanoma is. This can be either isolated limb infusion or isolated limb perfusion
targeted cancer drugs
immunotherapy
chemotherapy into your bloodstream (intravenous)
radiotherapy
If your doctor finds melanoma cells in an SLNB they call this microscopic disease. They might suggest you have:
regular ultrasound scans
targeted cancer drugs or immunotherapy
You don’t usually need to have the rest of the lymph nodes in the area removed in this situation.
But sometimes they might recommend you do. The operation is called a completion lymph node dissection or lymphadenectomy. Your doctor might suggest this if:
the melanoma is on your head or neck
you can’t have targeted or immunotherapy drugs
you can’t have regular scans or checks with your doctor to monitor the lymph nodes
If your lymph nodes are swollen, your doctor usually does recommend a completion lymph node dissection.
Your doctor might offer you treatment after surgery. This is called adjuvant treatment. The aim is to reduce the risk of the cancer coming back.
You might have targeted cancer drugs or immunotherapy for a year.
Read more about targeted cancer drugs and immunotherapy for melanoma skin cancer
Stage 4 means the cancer has spread to other parts of the body, such as the liver. It is also called advanced or metastatic melanoma skin cancer.
Targeted cancer drugs and immunotherapy are the main treatments for stage 4 melanoma. Occasionally you might have surgery if the surgeon thinks they can remove all of the cancer. And in Scotland, some people may be able to have immunotherapy before their surgery.
But these treatments are not an option for everyone.
Other treatments include:
radiotherapy to specific sites of melanoma spread, for example the bone or brain
injecting a drug directly into the melanoma (intralesional therapy), for example Talimogene laherparepvec (T-VEC)
chemotherapy combined with an electric current (electrochemotherapy)
chemotherapy into your bloodstream (intravenously) – usually you would only have this if you are not able to have targeted cancer drugs or immunotherapy
Find out more about advanced melanoma skin cancer
Unfortunately, melanoma skin cancer may come back. Any further treatment you have will depend on factors such as:
where it is
what treatment you have already had
your general health and level of fitness
Your doctor will explain what your treatment options are and how they may affect you.
Finding out the cancer has come back can be a shock and devastating news. It's common to feel uncertain and anxious, and it can be difficult to think about anything else.
Take your time to think about the treatment your doctor recommends. You might find it helpful to talk to your specialist nurse about any worries you have about it. This can help you choose what is best for you.
You may also want to talk things over with a close friend or family member. Or there may be a counsellor you can discuss your feelings with.
Find out about counselling and cancer
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
To make sure the research is accurate, each trial has certain entry conditions for who can take part. These are different for each trial. Your doctor may ask you to take part in a trial if you fit the entry conditions. Sometimes you may have new treatments that you wouldn’t be able to have if you weren’t in the trial.
Find out more about clinical trials for melanoma skin cancer
Last reviewed: 06 Jan 2025
Next review due: 06 Jan 2028
The stage of a melanoma skin cancer tells you how deeply it has grown down into the skin. It also tells you if it has spread elsewhere in your body and how far.
Surgery is the main treatment for melanoma skin cancer. The type of surgery you need depends on the stage of the melanoma and where it is in your body.
You may have targeted cancer drugs or immunotherapy after surgery. Which type you have depends on if the melanoma has any gene changes or not.
Radiotherapy isn't a common treatment for melanoma skin cancer. Some people may have it after surgery or for melanoma that has spread elsewhere in the body (advanced melanoma).
There are different ways to have chemotherapy for melanoma skin cancer including into your bloodstream or with an electric current. But it isn't a common treatment.
Melanoma develops in cells called melanocytes. You have these in your skin and other parts of your body. Melanoma that starts in the skin is called melanoma skin cancer.
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