Treatments for locoregional melanoma skin cancer

Locoregional melanoma skin cancer means that it has spread to nearby lymph nodes, to nearby areas of skin (called satellite tumours) or to lymph vessels (called in-transit metastasis). This includes any stage 3 melanoma.

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

Surgery

Surgery is a standard treatment for locoregional melanoma.

A wide local excision (sometimes called surgical resection) removes the tumour and a small amount of healthy tissue around it (called the surgical margin). The size and depth of the surgical margin depends on how thick the tumour is and where it is on the body.

A complete lymph node dissection removes a group of lymph nodes. It can be done at the same time as wide local excision or during a second surgery. The type of lymph node dissection done depends on which and how many lymph nodes contain cancer. A complete lymph node dissection may be done if the doctor feels any enlarged lymph nodes and an imaging test shows that lymph nodes contain cancer cells.

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.

If surgery can't be done for locoregional melanoma, doctors may treat it the same as metastatic melanoma. Find out more about treatments for metastatic melanoma skin cancer.

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered immunotherapy after surgery for locoregional melanoma. It can help lower the risk that the cancer will come back (recur).

The immunotherapy drugs that may be used include:

nivolumab (Opdivo)
pembroluzimab (Keytruda)

Find out more about immunotherapy for melanoma skin cancer.

Targeted therapy

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 may be offered for locoregional melanoma with a BRAF V600E or BRAF V600K gene mutation.

Trametinib (Mekinist) combined with dabrafenib (Tafinlar) can be used after surgery to treat melanoma that has spread to nearby lymph nodes. These drugs are taken as a pill by mouth (orally) daily for 1 year.

Find out more about targeted therapy for melanoma skin cancer.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be offered after surgery for certain cases of locoregional melanoma. It is used to lower the risk of the cancer coming back in the same area where the cancer was removed (local recurrence) if:

cancer cells are found in tissues around the tumour removed during surgery (called a positive surgical margin) but more surgery is not possible
there are high-risk features, such as multiple lymph nodes in one area contain cancer

External radiation therapy is aimed at the area of skin where the cancer and lymph nodes were removed.

Find out more about radiation therapy for melanoma skin cancer.

Clinical trials

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.

Elaine McWhirter, MD, MSc, FRCPC
Philip Wong, MD, MSc, MDCM, FRCPC
Frances Wright, MD, FRCSC

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