Treatment Options for Stage III Melanoma

After your stage of melanoma has been identified, your doctor will discuss a plan of treatment with you. It is important to know whether all of your Stage III melanoma has been completely removed with surgery (known as “resected Stage III”) or if it was not possible to remove all of the melanoma (know as “unresectable Stage III”). These two types of Stage III melanoma are treated very differently. Unresectable Stage III patients are treated similarly to Stage IV melanoma patients.

Surgery

The purpose of the surgery is to remove any cancer remaining after the biopsy of the primary melanoma. This procedure is called a wide local excision. Wide local excision is recommended for small, easily removable recurrent tumors and for patients with a limited number of in-transit tumors.

The surgeon removes the tumor, including the biopsy site, as well as a surgical margin, (a surrounding area of normal-appearing skin), and underlying subcutaneous tissue. Most surgeons follow the guidelines adopted and recommended by the National Institutes of Health and the World Health Organization Melanoma Program.

  • The recommended margins for wide local excision of the primary melanoma ranges from 1-2cm and is determined by the thickness of the primary melanoma.
Learn more about surgery

Lymph Node Dissection

When cancerous lymph nodes are found and there is evidence that the melanoma has spread to nearby lymph nodes, an additional surgery to remove the remaining lymph nodes from the area is usually recommended. If your melanoma was found by sentinel lymph node biopsy this is called a complete lymph node dissection (CLND). If your melanoma was found because your lymph nodes were enlarged, this is called a therapeutic lymph node dissection (TLND).

The goal of the surgery is to prevent further spread of the disease through the body by way of the lymphatic system. Current studies are underway to determine whether CLND and TLND may also prolong survival.

CLND and TLND also play an important role in controlling the pain often caused by untreated lymph node disease.

Sentinel Lymph Node Biopsy (SLNB)

If a patient has already been diagnosed with Stage III melanoma, a SLNB is typically recommended only when it is suspected there might be melanoma in another lymph node basin.

The results of the biopsy will guide the course of treatment.

Learn more about SLNB

Adjuvant Therapy

Systemic treatment, given after surgery to remove all the melanoma, is often recommended for Stage III melanoma. These systemic therapies go in the bloodstream in an effort to reach and destroy any remaining cancer cells throughout the body.

Immunotherapies

INTRON A (high-dose interferon alfa-2b)

Purpose and Effectiveness

  • High-dose interferon is given to rev up the immune system in order to kill melanoma cells. Interferon is given to prevent the cancer from coming back after initial therapy, such as surgery.
  • When compared with patients who had no adjuvant treatment (treatment following surgery), Intron A was effective at preventing melanoma relapse. It extended the relapse free period from 0.98 years to 1.72 years. Five year-survival was 46% for those who took the drug compared to 37% for those who did not.

Learn more about Intron A.

SYLATRON (peginterferon alfa-2b)

Purpose and Effectiveness

  • Sylatron is given to rev up the immune system in order to kill melanoma cells. Sylatron is given to prevent the cancer from coming back after the initial therapy, such as surgery.
  • Sylatron is effective in delaying or preventing relapse of melanoma. The drug has not demonstrated a benefit on overall survival.

Learn more about Sylatron

Clinical Trials

Clinical trials are research studies to evaluate new therapies and improve cancer care. These studies are responsible for most of the advances in cancer prevention, diagnosis, and treatment. If you have melanoma, you may be eligible to participate in a clinical trial.

Several treatments for Stage IV melanoma are currently being tested in clinical trials for Stage III.

  • Yervoy (ipilimumab), Keytruda (pembrolizumab), Opdivo (nivolumab), and other therapies designed to boost the immune system to fight the return of melanoma
  • Targeted therapies and targeted therapy combinations that work by blocking the function of the  mutated BRAF protein
  • Vaccines that may improve the specific immune response to melanoma
Learn more about clinical trials

Stage III Unresectable Treatments

Unresectable melanoma means that it was not possible to remove all of your melanoma. Stage III unresectable patients are treated similarly to Stage IV melanoma patients.

Surgery

See Stage III above.

Lymph Node Dissection

See Stage III above.

Sentinel Lymph Node  Biopsy (SLNB)

See Stage III above.

Adjuvant Therapy

Immunotherapies

KEYTRUDA (pembrolizumab)

Purpose and Effectiveness 

  • Keytruda is designed to block a cellular target known as PD-1, which restricts the body’s immune system from attacking melanoma cells. It works by increasing the ability of the body’s immune system to fight advanced melanoma.
  • In a large Phase 1 clinical trial, half of the participants received Keytruda at the recommended dose of 2 mg/kg. Of these patients, approximately 24% had their tumors shrink. This effect lasted at least 1.4 to 8.5 months and continued beyond this period in most patients.

Learn more about Keytruda

OPDIVO (nivolumab)

Purpose and Effectiveness

  • Opdivo is a humanized monoclonal antibody. It is designed to block a cellular target known as PD-1, which results in an anti-tumor immune response.
  • The approval of Opdivo was based on the results of a Phase III clinical trial of 120 patients with unresectable (cannot be removed by surgery) or metastatic (advanced) melanoma. Of these patients 32 percent had a response to Opdivo. This effect lasted for more than six months in approximately one-third of the patients. Responses to Opdivo were demonstrated in both patients with and without the BRAF V600 mutation.

Learn more about Opdivo

YERVOY (ipilimumab)

Purpose and Effectiveness 

  • Yervoy is designed to restore and strengthen the immune system by successfully activating T-cells (T lymphocytes), a critical component of the immune system, with the hope of sustaining an active immune response to fight the cancer cells for a long time.
  • Studies indicate that Yervoy improves overall median survival by 4 months compared to a vaccine treatment. In a 2013 analysis from 12 prospective and retrospective studies it was shown that the median overall survival for patients treated with Yervoy was 11.4 months. Among these patients, 22% were still alive after three years. There were no deaths among patients who survived beyond seven years, at which time the overall survival rate was 17%.

Learn more about Yervoy

Targeted Therapies

MEKINIST (trametinib) and TAFINLAR (dabrafenib) Combo

Purpose and Effectiveness

  • In patients with a BRAF mutation, Tafinlar in combination with Mekinist blocked the cellular pathway to inhibit the growth of melanoma metastases.
  • In a phase III trial comparing Tarinlar in combination with Mekinist versus Zelboraf alone in patients with BRAF V600E or V600K mutations, the combination group had a progression free survival of 11.4 months compared to 7.3 months in the Zelboraf only group.

Learn more about Tafinlar in combination with Mekinist

MEKINIST (trametinib)

Purpose and Effectiveness

  • Mekinist blocks a cellular pathway to stop the growth of melanoma tumors.
  • In a trial comparing trametinib to chemotherapy (dacarbazine or paclitaxel) in patients with metastatic melanoma with a BRAF V600E or V600K mutation, the trametinib group had improved overall survival compared with chemotherapy.
  • Mekinist has not shown to benefit patients who have already taken another BRAF inhibitor and is only used alone in patients who cannot take Zelboraf or Taflinar.

Learn more about Mekinist

TAFINLAR (dabrafenib)

Purpose and Effectiveness

  • Tafinlar blocks a cellular pathway to stop the growth of melanoma tumors.
  • In a trial comparing Tafinlar to chemotherapy in patients with the BRAF V600E mutation, the Taflinar group had progression free survival (the time a patient lives without cancer growing or spreading) of 6.9 months compared to 2.7 months for those on chemotherapy.

Learn more about Tafinlar

ZELBORAF (vemurafenib)

Purpose and Effectiveness

  • The BRAF protein is normally involved in regulating cell growth, but is mutated (abnormal) in about half of patients with late-stage melanomas. Vemurafenib and dabrafenib work by blocking the function of the V600E-mutated BRAF protein.
  • In a trial comparing Zelboraf to chemotherapy in patients with the BRAF V600E mutation, the chemotherapy group had a median survival time of 9.7 months, with 44% still living at one year. Median survival time in the Zelboraf group was 13.6 months, with 56% still living at one year.

Learn more about Zelboraf

Radiation Therapy

Radiation therapy in the adjuvant setting has been shown to improve local control (in the lymph node basin) but has not been proven to improve overall survival (living longer) in randomized, controlled studies.

Learn more about radiation therapy

Clinical Trials

Clinical trials are research studies to evaluate new therapies and improve cancer care. These studies are responsible for most of the advances in cancer prevention, diagnosis, and treatment. If you have melanoma, you may be eligible to participate in a clinical trial.

For more information, see the clinical trials section in Stage IV melanoma

Patient & Caregiver Symposiums

Join leading melanoma experts in an educational symposium for patients and the people who support them.

Sign up today

Related Content

What to Ask Your Doctor About Stage III Melanoma

It is important to use the time with your doctor to learn as much about your cancer as you can. Find questions you may want to ask him/her.

Stage III Follow-Up

Follow-up care is important after being treated with melanoma. Learn about a plan for your stage.

Find a Melanoma Specialist

Please keep me informed.

Receive comprehensive, breaking news about melanoma, research, legislation, and events.

  • This field is for validation purposes and should be left unchanged.