Treatment follows the stage. Early melanoma is treated with surgery alone. For higher stages, drug treatment before or after surgery now lowers the chance of the cancer coming back.
Surgery is the treatment. The surgeon removes the biopsy site with a margin of normal skin, an operation called a wide local excision, usually under local anesthesia. For stage IB melanomas and those with higher-risk features, doctors also discuss a sentinel lymph node biopsy. On the face, where wide margins are hard to take, options for stage 0 include Mohs surgery, imiquimod cream, and radiation.1
Wide excision remains the core treatment, and a sentinel node biopsy is usually discussed. People with stage IIB and IIC melanoma may be offered a checkpoint inhibitor for about a year after surgery to lower the risk of recurrence. Close follow-up without a drug is also an accepted choice, since these drugs can cause lasting side effects.1
Melanoma has reached the lymph nodes or nearby skin. Treatment combines surgery with immunotherapy or, for tumors with a BRAF mutation, targeted therapy.1 The order matters. In the SWOG S1801 trial of 313 patients, starting pembrolizumab before surgery gave better event-free survival than giving all of it afterward.2 The NADINA trial of 423 patients found the same advantage for nivolumab plus ipilimumab given before surgery.3
Melanoma has spread to distant organs. First-line treatment is usually a checkpoint inhibitor: pembrolizumab or nivolumab alone, nivolumab with relatlimab, or nivolumab with ipilimumab. Combinations work more often and cause more serious side effects. Tumors with a BRAF mutation, about half of melanomas, can also be treated with a BRAF inhibitor paired with a MEK inhibitor.1
Later options include tumor-infiltrating lymphocyte therapy (lifileucel), an injected virus therapy given with nivolumab, and clinical trials.4 Surgery and radiation still help when there are only a few metastases, including in the brain.
Every drug now used for melanoma reached patients through a trial. Trials exist for every stage, and many test new treatments against the current standard of care. Ask your oncologist whether one fits your situation.
Margins, anesthesia, and recovery.
Who is offered it and the trade-offs.
Why the order of treatment matters in stage III.
Which symptoms need a same-day call.
BRAF and MEK inhibitors explained.
Phases, consent, costs, and how to search.
Reviewed against these sources in September 2026. Figures change every year, and this page is updated when new estimates are released.
