Treatments for locally recurrent melanoma skin cancer

Locally recurrent melanoma skin cancer means that it has come back in the same place as or close to where the cancer was removed with surgery.

The most common places for local recurrences are:

• on the skin close to where the cancer started (called satellite tumours)
• in nearby lymph vessels (called in-transit metastases)
• in the area of the original scar or in nearby lymph nodes (also called a regional or nodal recurrence)

The following are treatment options for locally recurrent melanoma. Your healthcare team will suggest treatments based on your needs and will work with you to develop a treatment plan.

Surgery is usually offered for locally recurrent melanoma.

A wide local excision( sometimes called surgical resection) removes a tumour on the skin and a small amount of healthy tissue around it (called the surgical margin).

A sentinel lymph node biopsy (SLNB) can help doctors decide if other treatments are needed. It is usually done for locally recurrent melanoma if it wasn't done as part of treatment for the original cancer. An SLNB finds and removes the first lymph node (or first few lymph nodes) in a group of lymph nodes to see if it contains cancer cells.

A complete lymph node dissection removes a group of lymph nodes. It is usually done if melanoma comes back in nearby lymph nodes. A complete lymph node dissection can be done at the same time as wide local excision or during another surgery. The type of lymph node dissection done depends on which and how many lymph nodes contain cancer.

A skin graft is when the surgeon removes skin from another area of the body and places it over the surgical area to cover the open wound and repair the skin. If the surgical wound is small, the surgeon may rotate a nearby piece of skin to cover the open wound.

Find out more about surgery for melanoma skin cancer.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy for locally recurrent melanoma. It is used after surgery to remove tumours or when there are many tumours that can’t be removed with surgery.

Aldesleukin (Proleukin or interleukin-2, IL-2) is the most common immunotherapy drug used. It is injected directly into a tumour (called intralesional treatment).

Imiquimod (Aldara, Zyclara) may be used with aldesleukin. Imiquimod is a cream that is applied directly to tumours on the skin.

Topical diphenylcyclopropenone (DPCP) is an immunotherapy drug that is applied to the skin as a cream.

Aldesleukin, imiquimod and topical DPCP are considered localized therapy. This means that the treatment is given directly in or on the surface of the tumours.

Immunotherapy may be offered as a systemic therapy if cancer has spread to several lymph vessels (called in-transit metastases). The drugs that may be used include:

• nivolumab (Opdivo)
• pembrolizumab (Keytruda)
• nivolumab and relatlimab (Opdualag)
• ipilimumab (Yervoy)

Find out more about immunotherapy for melanoma skin cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Targeted therapy is sometimes offered for recurrent melanoma with certain gene changes (mutations), including mutations in the BRAF gene.

The targeted therapy drugs used to treat locally recurrent melanoma include:

• dabrafenib (Tafinlar) combined with trametinib (Mekinist)
• vemurafenib (Zelboraf) combined with cobimetinib (Cotellic)
• encorafenib (Braftovi) combined with binimetinib (Mektovi)

Targeted therapy drugs are taken as a pill by mouth (orally) daily. How long treatment is given depends on the type of drug used and how well the cancer responds to treatment.

Find out more about targeted therapy for melanoma skin cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy to treat locally recurrent melanoma. It is also used as a palliative treatment to control symptoms when surgery or other treatments can’t be done.

External radiation therapy is aimed at the area of skin or the lymph nodes where the cancer has recurred. How long it is used depends on the number and size of the tumours, the type and dose of radiation therapy used, how severe symptoms are and other factors.

Stereotactic radiation therapy is a type of external radiation therapy. It may be used when small areas of cancer are found and need to be treated. It delivers a high dose of radiation to a very specific area of the body.

Find out more about radiation therapy for melanoma skin cancer.

Talk to your doctor about clinical trials open to people with melanoma in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.