What Is Adjuvant Therapy for Melanoma, and How Does It Work?

Melanoma is the least common, but most serious form of skin cancer. Almost 200,000 people in the U.S. develop melanoma, and about 7,500 will die from it each year.

When it’s caught early, melanoma can usually be treated with surgery alone. More advanced melanoma, however, may need more treatment to help keep it from coming back. This type of treatment is called adjuvant therapy, and it includes several different medications.

What is adjuvant therapy for melanoma?

Adjuvant therapy is treatment that’s given after melanoma has been removed with surgery. The goal of adjuvant therapy is to target any remaining cancer cells that are too small to be seen on scans. This lowers the risk of the melanoma coming back (also called a recurrence).

Adjuvant therapy is usually recommended for people with more advanced and aggressive melanoma. This is because they have a higher risk of the melanoma coming back.

When is adjuvant therapy given? 

Not all melanomas need adjuvant therapy. It depends on a few different things. A person’s preference is important, as is their general health. Not everyone with melanoma will choose to have adjuvant therapy or be able to tolerate it. 

Your oncology team may recommend adjuvant treatment based on the specific features of your melanoma. These include:

1. Melanoma stage

Adjuvant therapy is recommended for more advanced melanoma stages. That’s because these cancers have a higher risk of coming back. Keep in mind even melanomas with the same stage can be different, so each situation is treated individually. Here are stages that may benefit from adjuvant therapy:

• Stage IIB or IIC (higher risk melanoma without positive lymph nodes)

• Stage IIIB, IIIC, or IIID (higher risk melanomas with positive lymph nodes)

• Stage IIIA (lower risk melanoma with positive lymph nodes)

2. Risk of melanoma coming back (recurrence)

Certain characteristics of the melanoma raise its risk of coming back. These features are seen under the microscope and included on the pathology report. Melanoma has a higher chance of recurring if it is:

• Thicker (deeper)

• Ulcerated (has skin breakdown above the melanoma)

• Growing quickly (has many dividing cells)

3. A BRAF mutation

The most common gene mutation found in melanoma is the BRAF oncogene. When this is present, adjuvant treatment with certain targeted medications can be helpful.

What drugs are used for adjuvant therapy?

Adjuvant therapy for melanoma can be one of two types of medications: immunotherapy and targeted therapy. Immunotherapy helps your own immune system recognize and kill cancer cells. Targeted therapy is medication that zeros in on specific melanoma cells.

These are the medications typically used for adjuvant melanoma therapy:

• Pembrolizumab (Keytruda)

• Nivolumab (Opdivo)

• Ipilimumab (Yervoy)

• Interferon (Intron A and Sylatron)

• Dabrafenib and Trametinib (Tafinlar and Mekinist)

How much does adjuvant therapy for melanoma cost? 

Adjuvant treatment for melanoma can be expensive. It can cost up to tens of thousands of dollars. For people with insurance (including Medicare and Medicaid), the cost is usually much lower — like hundreds of dollars or even less. If you don’t have insurance, some pharmaceutical companies have programs to help lower the costs of their medications.

What are the side effects of adjuvant therapy?

The side effects of adjuvant therapy depend on the individual medication used. There are some common side effects that can happen with most of them, such as:

• Diarrhea

• Nausea and poor appetite

• Skin rash or sun sensitivity

• Feeling tired

• Muscle and joint pain

• Thyroid function problems

• Headache

• Hair loss

There are some less common, but more serious, side effects with some of these medications, like:

• Allergic reactions

• Autoimmune reactions (like arthritis)

• Heart rhythm problems

• Damage to organs (like the liver or lungs)

Are there alternatives to adjuvant therapy for melanoma?

Yes. One option is not getting any adjuvant melanoma therapy. For some people, especially those with low-risk disease, this may be a good choice. They may want to avoid the side effects associated with these treatments.

Another alternative treatment is adjuvant radiation therapy. Radiation treatment works by using high-energy waves or particles (like X-rays) to kill cancer cells. Because more effective medications have been developed, adjuvant radiation therapy isn’t usually recommended as the first choice. But this may be an option in some situations. For example, if the melanoma is in an area where getting adequate margins with surgery is hard, like the face. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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