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What is melanoma?
Melanoma starts in melanocytes, the cells that give skin its color. It can appear as a new spot or a change in an existing mole, and unlike more common skin cancers it can spread to other parts of the body if not caught early. The encouraging news is twofold: most melanomas are found early and cured by simply removing them, and for the minority that spread, immunotherapy and targeted drugs have dramatically improved survival over the past decade. Sun exposure and tanning beds are major, preventable risk factors.
The main types
Doctors group melanoma by where it starts and how it behaves:
| Type | What it means, simply |
|---|---|
| Superficial spreading melanoma | The most common type; spreads outward across the skin first, giving time to catch it early. |
| Nodular melanoma | Grows downward more quickly as a raised bump; important to recognize and treat promptly. |
| Lentigo maligna & acral lentiginous | Lentigo maligna appears on sun-damaged skin in older adults; acral types occur on palms, soles, or under nails and can affect any skin tone. |
Staging, in plain terms
Melanoma staging leans heavily on how deep the tumor reaches into the skin (Breslow thickness) and whether the surface is broken (ulceration), along with T (tumor), N (lymph nodes), and M (metastasis/distant spread).
| TNM (with tumor thickness) | What it generally means |
|---|---|
| Stage 0 | Melanoma in situ — confined to the top layer of skin. Cured by removing it. |
| Stage I | Thin melanoma with no spread. Excellent cure rate with surgery alone. |
| Stage II | Thicker melanoma, still local, but with a higher chance of return — so it is watched more closely. |
| Stage III | Spread to nearby lymph nodes or skin. Treated with surgery plus medicines that lower the chance of recurrence. |
| Stage IV | Spread to distant organs. Modern immunotherapy and targeted drugs now control or shrink many of these cancers, sometimes for years. |
The standard of care
Melanoma is almost always treated by a team that may include a surgeon, a medical oncologist, and a radiation oncologist, combining therapies for the best result. The usual building blocks are:
Surgery
The main treatment — removing the melanoma with a margin of healthy skin. For deeper tumors, a nearby 'sentinel' lymph node may be checked for spread.
Systemic medicine (immunotherapy / targeted)
Immunotherapy unleashes the immune system against melanoma; targeted pills work when the tumor carries a BRAF mutation. Both are used for advanced disease and to prevent recurrence.
Radiation therapy
Used in select cases — to treat lymph-node areas at high risk of return, hard-to-remove tumors, or to relieve symptoms from spread, including in the brain.
How radiation treatment works
Radiation uses focused high-energy x-rays to damage cancer-cell DNA so the cells can no longer divide. While surgery is the mainstay for most melanoma, radiation is a valuable tool for specific situations, delivered with image guidance that concentrates the dose on the target and protects surrounding tissue. For melanoma in the brain, stereotactic radiosurgery treats spots with millimeter precision. Treatments are painless and brief; side effects depend on the area treated and are usually localized and temporary.
The main ways radiation is delivered for melanoma:
Adjuvant nodal radiation
Targeted radiation to a lymph-node region after surgery can reduce the chance the melanoma returns there when the risk is high.
Stereotactic radiosurgery (SRS)
Highly focused radiation precisely treats melanoma that has spread to the brain in one or a few sessions, often combined with immunotherapy.
Radiation for lentigo maligna / non-surgical cases
When surgery is difficult — for example, large facial lentigo maligna in older patients — focused radiation can be an effective alternative.
Latest studies shaping care
Care keeps improving — often toward getting the same excellent results with less burden on patients. A few developments:
Immunotherapy transforms survival: Checkpoint immunotherapy has turned advanced melanoma from a rapidly fatal disease into one where many patients achieve long-lasting remission.[1]
CheckMate and KEYNOTE melanoma trials · PMID 31562797 (opens in a new tab)
Radiation plus immunotherapy for brain spread: Combining stereotactic radiosurgery with immunotherapy improves control of melanoma brain metastases and is now common practice.[2]
Multi-center SRS + immunotherapy series
mRNA cancer vaccines: A personalized mRNA vaccine added to immunotherapy reduced the risk of melanoma returning after surgery in early trials, pointing to a new prevention strategy.[3]
KEYNOTE-942 / mRNA-4157 trial · PMID 38246194 (opens in a new tab)
Common questions
How do I spot melanoma early? Watch for the ABCDEs of a mole: Asymmetry, Border irregularity, Color variation, Diameter larger than a pencil eraser, and Evolving or changing over time. Show any new or changing spot to a clinician.
Does melanoma get treated with radiation like other skin cancers? Usually not first — melanoma is mainly removed surgically. Radiation is reserved for specific situations, such as high-risk lymph nodes, brain spread, or tumors that are hard to remove.
Is advanced melanoma still a death sentence? No. Immunotherapy and targeted drugs have dramatically improved outcomes, and many people with advanced melanoma now live for years, some with no detectable disease.
References
Numbered sources for the studies cited above. Links open the primary publication on PubMed or the publisher’s site.
- Wolchok JD, Chiarion-Sileni V, Gonzalez R, Rutkowski P, Grob JJ, Cowey CL, et al. Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2019;381(16):1535-1546. (opens in a new tab) PMID 31562797 ↩
- Multi-center SRS + immunotherapy series (no indexed identifier — see your care team) ↩
- Weber JS, Carlino MS, Khattak A, Meniawy T, Ansstas G, Taylor MH, et al. Individualised neoantigen therapy mRNA-4157 (V940) plus pembrolizumab versus pembrolizumab monotherapy in resected melanoma (KEYNOTE-942): a randomised, phase 2b study. Lancet. 2024;403(10427):632-644. (opens in a new tab) PMID 38246194 ↩