The primary treatment for melanoma is surgical removal of the tumor. For metastatic melanoma or in cases when surgery is not an option, immunotherapy or targeted therapy may be used.

Immunotherapy, or biological response modifier therapy, involves using medications to boost the effects of the body's immune system to recognize and kill cancer cells. These medications are given through an IV or injected under the skin.

Types of immunotherapy medications include:

  • Cytokines—Signals and boosts the body's natural immune response of white blood cells called lymphocytes. A different cytokine can inhibit cancer cells from dividing. This will help slow the growth of the tumor.
  • PD-1 inhibitors—PD-1 is a protein found on the surface of T-cells to keep them from attacking the body's own cells. Blocking the effects of PD-1 allows the T-cells to recognize and kill cancer cells.
  • CTLA-4 inhibitors—Like PD-1 inhibitors, CTLA-4 inhibitors block the effects of a protein found on the surface of the T-cells.
  • Oncolytic virus therapy—A virus is injected directly into a tumor or lymph node when surgery cannot be done. The virus kills the cancer cells and shrinks the tumor.
  • Bacille Callmette-Guérin (BCG) vaccine—BCG is a form of the bacteria that causes tuberculosis. It is injected directly into a tumor where it stimulates an immune response.
  • Topical imiquimod—A cream is applied to the skin for stage 0—melanoma in situ or tumors in sensitive areas of the body. The cream stimulates an immune response. Because of potentially serious skin reactions, it may not be suitable for everyone.

Side effects include chills, fever, aches, depression, skin reactions, and fatigue.

About half of melanomas have a gene mutation known as BRAF. This gene causes the body to make proteins that accelerate the growth of cancer cells. Targeted therapy uses medications to seek out the cells with the BRAF mutation and destroy them.

Targeted therapy medications include:

  • Vemurafenib
  • Dabrafenib
  • Trametinib
  • Cobimetinib

Although these medications do not offer a cure for advanced melanoma, they can prolong life. The most common side effects are joint pain, fatigue, hair loss, rash, itching, sensitivity to the sun, and nausea.