Melanoma medications & treatments
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Melanoma is a serious type of skin cancer that an estimated 200,000 Americans will be diagnosed in 2022. Of those 200,000 newly diagnosed cases, around 7,650 will die. While melanoma accounts for only about 1% of all skin cancers, it has the highest risk of death. It’s one of the most common cancers in people under 30, especially in women. It can affect people of any age, race, or gender. The cases of melanoma have increased significantly in the past 30 years, especially in people under the age of 30. This is thought to be due to increasing levels of ultraviolet (UV) exposure.
What is melanoma?
Melanoma is a skin cancer (cutaneous melanoma) that develops in the skin cells that produce melanin, called melanocytes. Melanin is what gives your skin its color (pigment). Melanoma can also form in other parts of the body including your eyes, nose, and throat. While it is less common than basal cell carcinoma and squamous cell carcinoma, melanoma can be more life-threatening if it’s not properly treated at an early stage.
There are 4 main types of melanoma:
- Superficial spreading melanoma. This is the most common type of people under the age of 40. It can begin as a new brown or black lesion, or as an existing spot, freckle, or mole. It is typically slow growing that appears on the upper layer of your skin (epidermis).
- Nodular melanoma. This is the most aggressive type of melanoma and it is most commonly found in people over the age of 65. It typically appears as a blue-black raised bump on sun-damaged skin but can spread quickly to the lower layer of the skin (dermis).
- Lentigo maligna melanoma. This type often develops in people over the age of 40. It usually appears as a large blotchy blue-black patch on the face, ears, neck, or head.
- Acral lentiginous melanoma. This is the most common type found in people of color and is commonly found on the soles of the feet, palms of the hands, or under the fingernails or toenails.
It is estimated that nearly 90% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from the sun or tanning beds. It’s likely, however, that a combination of factors, including environmental and genetic factors, causes melanoma, such as:
- Excessive sun exposure or artificial forms of UV radiation such as tanning beds
- Fair skin, freckles, blond or red hair, and light-colored eyes
- History of sunburns
- Family history of melanoma
- Previous personal history of melanoma
- Have many moles (nevi) or unusual moles
- Have a weakened immune system
- Genetic disorders such as albinism
How is melanoma diagnosed?
Melanoma can be initially self-diagnosed or during a routine exam. If you have any of the “ABCDE” warning signs, your doctor or dermatologist will typically perform a biopsy on the affected lesion to determine the stage and if it has spread to any other part of your body. This will help guide the type of treatment you receive.
Melanoma is categorized into the following stages:
- Stage 0: The tumor is only in the outer layer of the skin (epidermis).
- Stage I: There are cancer cells in the epidermis and below it in the dermis.
- Stage II: The cancer cells are still located in the epidermis and dermis and may have ulceration. There is no evidence it has spread.
- Stage III: There is evidence it has spread to nearby lymph nodes or other areas of the skin.
- Stage IV: The metastatic melanoma has spread to distant skin and lymph nodes, lungs, liver, brain, bone, and/or intestines.
If you find a mole remember the ABCDEs of melanoma:
- Asymmetry: The 2 sides do not match.
- Border: The edges are uneven and not smooth.
- Color: It has 2 or more colors.
- Diameter: It is bigger than 6mm (1/4 inch) or the size of a pencil eraser.
- Evolving: It is changing in size, shape, or color.
Once a biopsy has confirmed the diagnosis, your doctor or oncologist may run additional tests to see if it has spread, including:
- Sentinel lymph node biopsy. This test finds the nearby lymph nodes the melanoma would likely spread to first and then removes it for a biopsy of it. It is then checked under a microscope for the presence of cancer cells.
- MRI to check for metastases in the brain or spinal cord.
- CT scan of your internal organs.
- PET scan of your lymph nodes or other regions of your body.
What are some melanoma treatment options?
Your treatment plan for melanoma will depend on the stage and it usually consists of a combination of medications, radiation, and surgery. Early detection is the key to minimizing the risks and complications.
Tumors that are discovered at an early stage and are localized to the upper layers of the skin can usually be completely resolved with excision surgery. For some people, this is the only treatment they will need.
If there is a suspected risk that it has spread to your lymph nodes, your doctor may remove the lymph nodes closest to the original melanoma. They may also recommend additional treatments such as medications or radiation.
- Immunotherapy. These injectable checkpoint inhibitors block certain proteins to help stimulate your immune system to fight the tumor. It can be used after surgery for malignant melanomas that have spread to other parts of your body. Examples include Yervoy (ipilimumab), Opdivo (nivolumab), and Keytruda (pembrolizumab).
- Targeted therapy. This revolutionary treatment inhibits specific mutated genes that play a role in the growth and spread of melanoma cells. About half of all people with melanoma have a BRAF mutation. BRAF inhibitors that target this mutation include Zelboraf (vemurafenib) and Tafinlar (Dabrafenib). For most patients, these medications work for a period of time before the melanoma develops resistance to them. MEK inhibitors are usually prescribed to address this and include Mekinist (trametinib) and Cotellic (cobimetinib). These medications are also used in combination and are effective in slowing disease progression with fewer side effects.
- Chemotherapy. Medications such as DTIC-Dome (dacarbazine) are usually used for advanced melanomas when surgery or other medications have failed. They are not very effective and can have serious side effects.
Radiation uses high-energy x-rays or other particles to destroy cancer cells. It is typically used after surgery to prevent melanoma from coming back. Radiation is also used to relieve pain and other symptoms caused by melanoma, especially in the brain or bones. For patients where surgery is a high risk or not possible, radiation is an option.
What is the best medication for melanoma?
The best medication for skin cancer treatment will depend on the individual’s specific medical melanoma, medical history, medications that the individual is already taking that may potentially interact with melanoma medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter melanoma medications approved by the Food and Drug Administration (FDA).
Best medications for melanoma
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|DTIC Dome (dacarbazine)||Antineoplastic||Injection||2-4.5mg/kg of weight via IV infusion once daily for 10 days, then repeat every 4 weeks.||Nausea, vomiting, injection site reactions, low platelet, and white blood cell levels
|Yervoy (ipilimumab)||Monoclonal antibody||Injection||3mg/kg of body weight via IV infusion every 3 weeks for up to 4 doses.||Rash, fatigue, diarrhea, itching
|Opdivo (nivolumab)||Monoclonal antibody||Injection||240mg via IV infusion every 2 weeks or 480mg IV every 4 weeks.||Elevated liver enzymes, low sodium, rash, itching, cough, high potassium, fatigue
|Keytruda (pembrolizumab)||Monoclonal antibody||Injection||200mg via IV infusion every 3 weeks or 400mg IV every 6 weeks.||High blood sugar and triglycerides, anemia, fatigue, rash, elevated liver enzymes
|Zelboraf (vemurafenib)||BRAF kinase inhibitor||Oral||4 tablets (960mg) every 12 hours.||Joint pain, rash, hair loss, fatigue, diarrhea, dry skin, QT prolongation
|Tafinlar (dabrafenib)||BRAF kinase inhibitor||Oral||2 capsules (150mg) twice daily.||High blood sugar, thickening of the skin, headache, joint pain, hair loss
|Braftovi (encorafenib)||BRAF kinase inhibitor||Oral||6 capsules (450mg) once daily.||Fatigue, nausea, vomiting, stomach pain, joint pain, rash, headache
|Mekinist (trametinib)||MEK inhibitor||Oral||1 tablet (2mg) once daily.||Elevated liver enzymes, rash, high blood sugar, anemia, diarrhea, headache
|Mektovi (binimetinib)||MEK inhibitor||Oral||3 tablets (45mg) twice daily.||Fatigue, nausea, diarrhea, anemia, vomiting, stomach pain, rash
|Temodar (temozolomide)||Antineoplastic||Oral||150-200mg/m2 daily for 5 days then repeat every 4 weeks.||Hair loss, nausea, vomiting, headache, fatigue, constipation
|Imlygic (talimogene laherparepvec)||Oncolytic immunotherapy||Injection||Up to 4ml injected into the lesion, repeat 3 weeks later, then every 2 weeks for at least 6 months.||Fatigue, chills, fever, nausea, injection site pain, vomiting, diarrhea, headache
|Intron A (interferon alfa 2b)||Immunomodulator||Injection||20 million units/m2 via IV infusion 5 days a week for 4 weeks, then 10 million units/m2 3 times a week for 48 weeks.||Fatigue, fever, flu-like symptoms, muscle aches, nausea, weakness, headache
|Opdualag (nivolumab/relatlimab)||Monoclonal antibody||Injection||480mg/160mg via IV infusion every 4 weeks.||Musculoskeletal pain, fatigue, rash, itching, diarrhea, headache
|Proleukin (aldesleukin)||Biological response modifier||Injection||The dose is a weight-based IV infusion every 8 hours for up to 14 doses, then 9 days of rest followed by up to 14 more doses.||Low blood pressure, diarrhea, chills, vomiting, rash, shortness of breath, nausea, decreased urine output
|Interleukin 2 (aldesleukin)||Biological response modifier||Injection||The dose is a weight-based IV infusion every 8 hours for up to 14 doses, then 9 days of rest followed by up to 14 more doses.||Low blood pressure, diarrhea, chills, vomiting, rash, shortness of breath, nausea, decreased urine output
Your healthcare provider will determine the right dosage based on your response to the treatment, medical melanoma, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of melanoma medications?
As with all medicines, those used for melanoma will have some side effects, depending on the class you are taking:
- Immunotherapy drugs can commonly cause rash, fatigue, diarrhea, itching, and elevated liver enzymes.
- Targeted therapy drugs can cause fatigue, diarrhea, rash, hair loss, joint pain nausea, and vomiting.
- Chemotherapy drugs commonly cause hair loss, nausea, vomiting, headache, fatigue, chills, and fever.
What are some home remedies for melanoma?
While your treatment of melanoma may include a combination of surgery, medications, and radiation, there are some ways to lower your risk and improve your quality of life.
- Avoid the sun when possible. If you have to be in the sun, the American Cancer Society recommends using a broad-spectrum, waterproof sunscreen with an SPF of at least 30.
- Do not use tanning beds.
- Wear protective clothing such as broad-brimmed hats, sunglasses, long-sleeved shirts, and pants.
- Check your skin regularly and notify your doctor of any changes.
- Eat a healthy diet. Try adding plenty of vegetables, green tea, fish, and other low-cholesterol, high-fiber foods.
Frequently asked questions about melanoma
Can melanoma be cured?
If diagnosed early, melanoma has a 5-year survival rate of around 99%. This drops dramatically in advanced stages. According to the American Cancer Society, the 5-year survival rate for stage 4 melanoma is 15-20%.
What causes melanoma?
Exposure to ultraviolet (UV) rays from sunlight and other sources, such as indoor tanning beds, is responsible for around 90% of melanoma cases. Family history, genetics, and other environmental factors are thought to also play a role.
Is there a vaccine for melanoma?
Currently, there is no vaccine for melanoma but clinical trials are ongoing for the treatment of advanced melanoma or to be used after surgery to prevent recurrence in high-risk patients.
Where does melanoma typically spread to?
Melanoma can spread to numerous areas of the body, including the bones, brain, liver, lungs, lymph nodes, and stomach.
Related resources for melanoma
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.