The short answer
Early melanoma is usually treated with surgery to remove it, which often cures it. For melanoma that has spread, immunotherapy and targeted therapy have become important and effective treatments.
Surgery to remove the melanoma is the main treatment for early disease and often cures it.
For melanoma that has spread, immunotherapy is an important treatment.
Targeted therapy helps melanomas with certain gene changes, such as BRAF.
Radiation and other treatments are used in some situations.
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The full explanation.
The simple version
Melanoma treatment starts with surgery for nearly everyone. For early-stage disease, surgery alone is often enough.
What changes as the stage goes up is what gets added afterward. Over the past decade, that "what's added" has shifted hard toward immunotherapy and targeted therapy. These treatments have changed the outlook for melanoma that has spread. That was once one of the hardest cancers to treat.
Surgery
Doctors call the main surgery a wide local excision. It removes the melanoma, plus a margin of normal skin around it. This is standard treatment at nearly every stage where surgeons can remove the tumor. The width of the margin depends on how thick the melanoma is. Thicker melanomas need a wider margin. For larger removals, you may need a skin graft to close the wound.
Some melanomas need one more step: a sentinel lymph node biopsy, done at the same time as the excision. This finds and removes the first lymph node that drains fluid from the tumor area. That's the node cancer would reach first if it spread. Doctors use a radioactive tracer or dye to find it.
Cancer cells in that node change the stage and the plan. A clear node is reassuring. It's not an absolute guarantee, though.
Stage 0 and I
Doctors also call stage 0 melanoma "melanoma in situ." It stays in the outer layer of skin. Treatment is surgery: removing the abnormal cells, plus a margin of normal tissue. That's usually the whole plan.
Stage I melanoma gets similar treatment. Surgeons excise it with a margin. Some tumors also need a sentinel lymph node biopsy, depending on thickness and other features. For many people at this stage, nothing more is needed.
Stage II
Doctors treat stage II melanoma with excision, usually with a sentinel lymph node biopsy too. Some stage II melanomas carry higher risk — thicker or more concerning tumors, even with a clear node. For those, doctors may add immunotherapy with pembrolizumab after surgery. Doctors call this "adjuvant" treatment: added after the main treatment, to lower the odds the cancer comes back.
Stage III
"Resectable" stage III melanoma means the cancer reached nearby lymph nodes, but surgeons can still remove it. Treatment combines several steps. Sometimes doctors give immunotherapy with pembrolizumab first, before surgery. Then comes the excision and lymph node surgery. After that, you may get more immunotherapy — nivolumab, pembrolizumab, or ipilimumab. Some melanomas carry a BRAF gene mutation instead. For those, doctors may give targeted therapy after surgery: dabrafenib plus trametinib, to lower the risk of recurrence.
Advanced or unresectable disease
Sometimes surgeons can't remove stage III melanoma. The same is true for stage IV melanoma, or melanoma that came back. Here, treatment centers on drugs that travel through your whole body, not surgery. Two kinds of drugs lead the way.
Immunotherapy uses checkpoint inhibitors: nivolumab, pembrolizumab, and ipilimumab. Doctors give these alone or combined. They work by releasing the brakes on your immune system's T cells. That lets your T cells attack melanoma cells better. These drugs have clearly improved long-term survival for advanced melanoma.
Targeted therapy works for about half of melanomas: the ones with a BRAF gene mutation. Doctors often call it BRAF V600. A biomarker test on tumor tissue finds this mutation. BRAF inhibitors — dabrafenib, encorafenib, or vemurafenib — usually get paired with a second drug, called a MEK inhibitor. Trametinib, binimetinib, and cobimetinib are the MEK inhibitors in use. NCI reports that the combination improves outcomes over a BRAF inhibitor alone. Side effects differ between the two approaches rather than simply being fewer, so ask your team what to expect from the pairing you are offered. This only applies to BRAF-mutated melanoma. That's why testing for the mutation comes first.
Doctors don't always agree on which comes first for BRAF-mutated advanced melanoma: immunotherapy or targeted therapy. Your oncologist weighs a few things. How fast is the cancer growing? How is your overall health? What side effects matter most to you?
What to ask your team
Ask whether a sentinel lymph node biopsy fits your tumor. Ask whether your melanoma has been tested for a BRAF mutation. For stage II or III disease, ask if your team recommends treatment after surgery, and why. For advanced disease, ask how your team is choosing between immunotherapy and targeted therapy for your case.
Sources
- National Cancer Institute — Melanoma Treatment (PDQ) Patient Version.
- National Cancer Institute — Melanoma Treatment (PDQ) Health Professional Version.
- National Cancer Institute — Immunotherapy Combination Better Than Sequential Treatment for Advanced Melanoma With BRAF Mutations.
- American Cancer Society — Melanoma Survival Rates by Stage.
Words to know
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Common questions
How is early melanoma treated?
Early melanoma is usually treated with surgery to remove it along with a margin of normal skin. For thin melanomas, this often cures the cancer.
How is advanced melanoma treated?
Melanoma that has spread is often treated with immunotherapy, which helps the immune system fight the cancer, and targeted therapy for melanomas with certain gene changes.
What is targeted therapy for melanoma?
Some melanomas have a change in the BRAF gene. Targeted therapy drugs can attack melanomas with these changes, so the tumor may be tested for them.
Is melanoma curable?
Early melanoma is often cured with surgery. Even advanced melanoma is now treated more effectively than in the past, thanks to immunotherapy and targeted therapy.
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Last updated: 2026-08-18Next planned review: 2027-07-07
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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