Key takeaways:
Adjuvant therapy helps lower the risk of melanoma coming back after surgery.
It may benefit people with higher-risk melanoma. Your oncology team can help you weigh the benefits and risks.
The main medications are immunotherapy and targeted therapy. The melanoma’s stage and gene mutations will help your care team determine the best treatment options for you.
Melanoma is a type of skin cancer that can spread to other parts of the body. Surgery alone can often treat early-stage melanoma. But for higher-risk melanoma, your care team may recommend additional treatment, even if surgery removed all the visible cancer.
This treatment, called adjuvant therapy, targets any remaining cancer cells to lower the chance of melanoma coming back. The main options are immunotherapy and targeted therapy. Here’s how they work and what to consider when deciding whether treatment after surgery is right for you.
What is adjuvant therapy for melanoma?
Adjuvant therapy is additional cancer treatment that follows the main treatment. For melanoma, you’ll start it after surgery, once you’ve recovered enough for treatment.
Treatment usually lasts about 1 year, but your oncology team may stop it sooner if serious side effects develop or cancer returns. Adjuvant therapy lowers the risk of recurrence, but it doesn’t guarantee that melanoma won’t come back.
Who needs adjuvant therapy?
Not everyone with melanoma needs adjuvant therapy. Your oncology team will consider several factors, including your overall health, personal preferences, and the melanoma’s features.
1. Advanced stage melanoma
Adjuvant therapy is recommended for advanced melanoma stages because these cancers are more likely to come back. These include:
Stage IIB or IIC: These stages refer to higher-risk melanoma that hasn’t spread to lymph nodes.
Stage IIIB, IIIC, or IIID: This is melanoma that has spread to nearby lymph nodes, skin, or tissues
Stage IIIA: This is melanoma with limited spread to nearby lymph nodes. Adjuvant therapy may be an option, but monitoring may be more appropriate for people with very small lymph node deposits.
Selected stage IV cases: This is melanoma that has previously spread to distant parts of the body, but surgery has since removed all known cancer.
Even melanomas with the same stage can have different recurrence risks, so your oncology team will tailor its recommendation to your situation.
2. High risk of melanoma coming back (recurrence)
Melanoma is more likely to come back if:
It’s thicker. This means it extends deeper into the skin.
It’s ulcerated. This means the skin over the melanoma has broken down.
It has a high mitotic rate. This means many cancer cells are actively dividing.
Your oncology team will consider these findings, along with your melanoma’s stage when deciding whether to recommend adjuvant therapy.
3. A BRAF mutation
Some melanomas have a mutation in the BRAF gene that helps cancer cells grow. When this is present, adjuvant treatment with certain targeted medications may be helpful.
What are the types of adjuvant therapy?
Adjuvant therapy can include several different types of treatment, depending on the cancer. Here are some of the most common adjuvant treatments.
Note: For melanoma, the main options are immunotherapy and targeted therapy.
Immunotherapy and targeted therapy
These are the main adjuvant medications for melanoma:
Immunotherapy: This helps your immune system recognize and attack cancer cells. Options include pembrolizumab (Keytruda) and nivolumab (Opdivo).
Targeted therapy: This blocks proteins that help cancer cells grow. For melanoma treatment after surgery, it’s an option for stage III disease with certain BRAF mutations. Options include dabrafenib (Tafinlar) and trametinib (Mekinist).
Older immunotherapies include ipilimumab (Yervoy) and interferon (Intron A, Sylatron). Doctors have used these after melanoma surgery, but they generally prefer newer treatments.
Radiation
Radiation therapy uses high-energy rays (like X-rays) to kill cancer cells in a specific area. It isn’t routinely used as adjunct therapy, but it may help with some melanoma subtypes in certain situations. For example, it might help when surgery can’t safely remove a wide enough margin of healthy tissue around the tumor.
Chemotherapy
Chemotherapy (or chemo) uses medications to kill cancer cells. It’s given after surgery for some cancers, but it isn’t a standard adjuvant treatment for melanoma.
Hormone therapy
Hormone therapy blocks hormones or lowers their levels to slow cancers that use hormones to grow (like some breast and prostate cancers). It isn’t used as adjuvant therapy for melanoma.
What are the side effects of adjuvant therapy?
The side effects that you might have with adjuvant therapy will depend on the particular medication that’s used.
Immunotherapy side effects
Common immunotherapy side effects include:
Feeling tired
Skin rash
Diarrhea or constipation
Nausea and poor appetite
Muscle and joint pain
Thyroid function problems
Less commonly, immunotherapy can cause your immune system to attack healthy tissues. This can lead to serious inflammation in the lungs, liver, intestines, or other organs. Some side effects may continue after you stop immunotherapy and require long-term treatment.
Targeted therapy side effects
Common side effects of Tafinlar and Mekinist include:
Fever and chills
Feeling tired
Skin rash
Nausea or vomiting
Diarrhea
Muscle and joint pain
Headache
Less common, but serious, side effects include developing other types of cancer, heart problems (including heart failure), eye pain or vision changes, colon or lung inflammation, and blood clots.
Tell your oncology team immediately about any new or worsening symptoms during or after treatment.
How do you decide if adjuvant therapy is right for you?
Deciding on adjuvant therapy means weighing its potential benefits against its risks. Your oncology team will consider your melanoma’s stage and recurrence risk, as well as your overall health. Your preferences matter, too.
Some questions to ask include:
How likely is my melanoma to come back without treatment?
How much would treatment lower that risk?
What side effects could be serious or permanent?
How would treatment affect my daily life and finances?
What would monitoring involve, if I don’t have treatment?
Together, you and your oncology team can choose a plan that fits your medical needs and priorities.
Are there alternatives to adjuvant therapy for melanoma?
Yes, there are alternatives to adjuvant therapy for melanoma. One option is active surveillance, or close monitoring without additional treatment. This may be a reasonable choice for people with lower-risk melanoma, or even when treatment risks outweigh the expected benefits. Depending on what stage the melanoma is, monitoring may include skin and lymph node exams, imaging, or lymph node ultrasounds.
Frequently asked questions
Neoadjuvant treatment is cancer treatment given before the main treatment (which is usually surgery). It’s usually done to shrink the tumor. For some people with melanoma, immunotherapy before surgery may be part of the treatment plan.
You may hear adjuvant therapy called “helper therapy” or “adjuvant treatment.” These describe its role: helping to lower the risk of cancer coming back after the main treatment.
The risks depend on the treatment. For melanoma adjuvant therapy, common side effects include fatigue, rash, nausea, or diarrhea. More serious risks include heart rhythm problems or autoimmune reactions (like arthritis). Some side effects may require stopping treatment or taking long-term medication.
Neoadjuvant treatment is cancer treatment given before the main treatment (which is usually surgery). It’s usually done to shrink the tumor. For some people with melanoma, immunotherapy before surgery may be part of the treatment plan.
You may hear adjuvant therapy called “helper therapy” or “adjuvant treatment.” These describe its role: helping to lower the risk of cancer coming back after the main treatment.
The risks depend on the treatment. For melanoma adjuvant therapy, common side effects include fatigue, rash, nausea, or diarrhea. More serious risks include heart rhythm problems or autoimmune reactions (like arthritis). Some side effects may require stopping treatment or taking long-term medication.
The bottom line
Adjuvant therapy is treatment given after melanoma surgery to lower the risk of cancer coming back. The main options are immunotherapy and targeted therapy. These treatments can help people with higher-risk melanoma, but they aren’t necessary for everyone.
Even melanomas with the same stage can have different recurrence risks. Your oncology team can help you weigh the potential benefits and side effects to choose a treatment plan that’s right for you.
Why trust our experts?
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