What Medications Are Used to Treat Melanoma?

Skin cancer is the most common type of cancer in the U.S. Melanoma only makes up a small percentage of cases, but it causes the most skin cancer deaths. And the rates of new melanoma cases have gone up over the past few decades. 

Surgery is usually the first step in treating melanoma. But medications may be used afterwards to lower the chance of it coming back. In other cases, they may be used if the melanoma can’t be removed, or if it has spread to other parts of the body (called metastatic melanoma).

Several different types of medications are used to treat melanoma. When and how they’re used depends on the stage of the melanoma and your specific situation. Read on to learn more about these treatments and how they work.

Immunotherapy

Immunotherapy works by making your immune system better at finding and attacking cancer cells. Common side effects of immunotherapy include rash, diarrhea, and feeling tired. Immunotherapy can also cause flu-like symptoms after treatment. 

There are a few different types of immunotherapy, and they work in different ways to treat melanoma. These include immune checkpoint inhibitors, immunomodulators, and oncolytic viral therapy. Depending on your specific situation, your oncologist will decide if and how immunotherapies may be used to treat your melanoma.

Immune checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) work by binding to immune checkpoint proteins on your body’s T cells (a type of immune cell). Some also bind to immune checkpoint proteins on tumor cells.

Immune checkpoints are proteins that help turn off T cell activity. Their role is to keep your body’s immune system in check. But ICIs block this “off” signal, allowing T cells to attack cancer cells. 

Several ICIs are approved to treat melanoma. They’re administered as an intravenous (IV) infusion into the vein. They target a few different immune checkpoint proteins to help your T cells attack cancer cells. 

Tebentafusp-tebn (Kimmtrak) is a new immunotherapy that can be used to treat certain types of uveal melanoma. Uveal melanoma is a specific type of melanoma that affects the eye. Kimmtrak works by binding both tumor cells and T cells. By bringing these cells together, T cells can work to kill the tumor cells.

Immunomodulators

Medications that boost your body’s immune response against cancer are called immunomodulators. Instead of blocking signals like ICIs, these medications are proteins that help many different types of immune cells become more active to kill cancer cells. 

One group of important proteins in your immune system’s ability to communicate are cytokines. Cytokines are made by white blood cells and help your body respond to different needs, like infections. Two types of cytokines used to treat melanoma are interferons and interleukins.

Interferons are naturally made in the body. But they’re also made in a lab for the purposes of helping the immune system fight cancer. Recombinant interferon alfa-2b (Intron A) is an interferon that’s approved to treat melanoma.

Interleukins have many functions to help the immune system. One specific protein, interleukin-2 (IL-2), helps boost the number and activity of white blood cells in the body. This can help the immune system kill cancer cells. Aldesleukin (Proleukin) is lab-made IL-2 that’s used to treat melanoma. It’s usually given as an IV infusion in the hospital to monitor for side effects.

Oncolytic viral therapy

Talimogene laherparepvec (T-VEC, Imlygic) is a viral therapy that’s injected directly into a lesion if a tumor comes back after surgery. 

T-VEC is an inactive virus made in the lab. It works by copying itself in the tumor that it’s injected in. Once copied, the virus grows in the tumor and destroys the cancer cells. It also helps the immune system to identify and attack cancer cells. 

Targeted therapy

Targeted therapy works by stopping the growth and spread of tumor cells. They do this by targeting specific parts of cancer cells, like a certain protein or gene mutation (change).

Targeted therapies used to treat melanoma are given as pills taken by mouth. Side effects vary depending on the medication. We’ll discuss these further below.

BRAF inhibitors

The most common mutations in melanoma are in the BRAF gene. They occur in about half of all melanomas. When DNA is mutated, the resulting protein changes. Mutated BRAF proteins allow cancer cells to grow. By targeting BRAF-mutated cells, BRAF inhibitors can slow their growth.

Three BRAF inhibitors can be used to treat melanomas that have a BRAF mutation. These include dabrafenib (Tafinlar), encorafenib (Braftovi), and vemurafenib (Zelboraf). They’re usually used in combination with MEK inhibitors (covered next) to make them work better. 

Common side effects from BRAF inhibitors include:

• Skin thickening

• Hair loss

• Rash, itching

• Sun sensitivity

• Headache

• Fever

• Joint pain

• Nausea

There are some rare but serious side effects with BRAF inhibitor treatment. New squamous cell cancers may develop, but are typically treated by surgically removing them. This tends to be more common if a BRAF inhibitor is given on its own. Your oncologist should check your skin during treatment and for a few months afterwards.

Other serious but less common side effects include:

• Heart problems

• Eye problems

• Liver or kidney problems

• High blood sugar

• High fever

• Bleeding

MEK inhibitors

When BRAF proteins are blocked, melanoma cells don’t grow well. Researchers discovered that another protein, called MEK, works closely with BRAF to help cells grow. 

MEK inhibitors work by blocking MEK proteins. They’re usually given in combination with BRAF inhibitors to treat melanomas with BRAF mutations. These medications include trametinib (Mekinist), binimetinib (Mektovi), cobimetinib (Cotellic).

Common side effects of MEK inhibitors include:

• Rash

• Diarrhea

• Swelling

• Sensitivity to sunlight

The risk of developing a second skin cancer is less common with combination BRAF and MEK inhibitor treatment.

KIT inhibitors

Some melanomas can have a mutation in the c-KIT gene. This gene is partially responsible for helping cells grow and divide. This mutation promotes cancer cell growth. 

In melanoma, these mutations happen mostly in the acral (palms of the hands, soles of the feet, under the nails) and mucosal (inside the mouth) areas. They can also occur on skin that gets exposed to a lot of sun (chronic sun damage).

When used to treat melanoma, only certain types of KIT mutations may be treated with KIT inhibitors. One medication that may be considered is imatinib (Gleevec). Imatinib is a pill taken by mouth. 

Common side effects of Gleevec include:

• Swelling

• Nausea, vomiting

• Muscle cramps

• Bone, muscle, or joint pain

• Diarrhea

• Rash or other skin reaction

• Stomach pain

• Feeling tired

• Headache

This treatment is off-label, meaning that the medication is approved by the FDA, but for other uses besides melanoma. Some research has been done, but bigger studies (like randomized controlled trials, the gold standard for cancer research) haven’t been completed. 

Chemotherapy

Chemotherapy medications work by killing rapidly dividing cells. They can be toxic and cause many side effects. Newer, more effective treatments like immunotherapy and targeted therapies are usually considered first. But chemotherapy may be an option after other treatments for some people.

Alkylating agents are one type of chemotherapy that can be used to treat melanoma. They work by damaging DNA in cancer cells, which keeps the cells from replicating.

Dacarbazine is an FDA-approved alkylating agent for melanoma. It’s given as an IV infusion. Common side effects include nausea and vomiting, loss of appetite, and lower production of blood cells.

Temozolomide (Temodar), carboplatin, and cisplatin are alkylating agents sometimes used off-label for melanoma. Temozolomide is given as an oral pill. Carboplatin and cisplatin are given as IV infusions. 

Keep in mind that chemotherapy regimens are highly variable for different cancers, including melanoma. Your oncologist will determine the right regimen for you.

Why trust our experts?

Written by:

Emmeline C. Academia, PharmD, BCOP

Emmeline C. Academia, PharmD, BCOP, has been a practicing clinical pharmacist in adult oncology since 2020. She is a clinical pharmacy specialist in oncology at Beth Israel Deaconess Medical Center, in Boston.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed 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.

Our editorial standards

Meet our experts