melanoma treatment

Melanoma Treatment at MedStar Georgetown

Malignant melanoma treatment requires the most experienced doctors and the most advanced therapy options. Our fellowship-trained surgical and medical oncologists at MedStar Georgetown University Hospital and Georgetown Lombardi Comprehensive Cancer Center offer you the highest level of expertise and care available in our area.

Our melanoma treatment team collaborates with a multidisciplinary group of experts to develop the most effective treatment options. We also use the most cutting-edge research and cancer clinical trials to manage your care. Plus, we specialize in giving second opinions to people who have received a diagnosis elsewhere.

We treat all of our patients with the MedStar Georgetown spirit of cura personalis, or care for the whole person. We spend time with you and your family to develop a treatment plan tailored to your needs. Most importantly, we offer all of our patients compassion, kindness and respect.

Melanoma or Skin Cancer Treatment Options

We offer a full range of effective treatments for melanoma. Early-stage melanomas can often get treated effectively with surgery alone, but more advanced cancers often require other approaches. Sometimes more than one melanoma treatment type is needed. Find a melanoma treatment specialist at MedStar Georgetown

Melanoma treatment options depend on:

  • The melanoma’s thickness, stage, rate of growth, and any genetic changes
  • Whether it has spread
  • Possible side effects
  • Your overall health
  • Your preferences

Surgery

Many melanomas are cut from the skin quickly and easily, with no further treatment needed — in fact, many times the disease is removed during the initial biopsy. If surgery is needed, our expert doctors provide several types:

  • Wide Local Excision: Excision is our standard approach, removing the cancer and up to two centimeters of surrounding tissue, with the amount and the degree of scarring dependent on the tumor’s thickness.
  • Mohs Micrographic Surgery: During Mohs surgery, the cancer is shaved off one thin layer at a time and checked under a microscope. Such a procedure is helpful when the tumor:
    • Has an unknown shape and depth
    • Is large
    • Has returned
    • Is located in a hard-to-treat spot, especially in the head and neck

Only doctors who are specially trained should perform Mohs surgeries, and we offer this expertise.

Sentinel Lymph Node Mapping and Biopsy

In some cases, our doctors may recommend a sentinel lymph node biopsy with lymphatic mapping (lymphoscintigraphy) before surgery. During this minimally invasive procedure, the doctor injects a dye and a (safe) radioactive substance at the site of the cancer, then watches to see which lymph node it migrates to first—the sentinel lymph node.

The lymph node is biopsied; if found clear, no further action is required. If it is not found clear, one or more lymph nodes may need to be removed—a surgery called dissection or lymphadenectomy - or close monitoring will be needed.

Patients with spread of their melanoma to lymph nodes are generally offered imaging studies to stage their disease and drug therapy to reduce the risk of recurrence. Learn more about specialized skin cancer procedures

Reconstruction and Grafting

Sometimes melanoma is located in a cosmetically sensitive area, or the doctor had to remove a large amount of tissue. If that’s the case, your dermatologic oncologist will partner with one of our expert plastic surgeons when the surgery is still in the planning stage.

After the surgery, the plastic surgeon repairs any visible scars. For larger tumors, the surgical site is reconstructed with a skin graft, taken from a discreet place elsewhere on your body. The team works hard to ensure you are happy with the final results.

Radiation for Melanoma

Our experienced radiation oncologists partner with our dermatologic oncologists to deliver the latest melanoma radiation therapy — high-energy rays or special radioactive sources that damage cancer cells and stop them from growing.

  • External Beam Radiation Therapy: External beam radiation uses a large machine to aim high-energy radiation beams at your cancer from outside your body. Our specialists treat as small an area as possible to avoid causing unnecessary damage to your healthy tissue.
  • High-Dose Rate (HDR) Brachytherapy: This is a method of brachytherapy that delivers radiation to the lesion at the surface of the skin. In HDR brachytherapy, a radioactive wire is attached to a highly specialized robotic machine. The robotic machine carefully guides the delivery of the radiation directly into the tumor and removes the wire after the session.
  • Total Skin Electron Therapy: Rotational Total Skin Electron Therapy (RTSEI) and static Total Skin Electron Irradiation (TSEI) are advanced approaches to treating this skin disorder. During TSEI, a patient's entire skin is treated with low-energy electrons. This radiation penetrates very superficially, protecting internal organs and other structures.
  • Proton Beam Therapy

Skin cancers can respond well to radiation therapy, and we may recommend it when:

  • You’ve had surgery for a type of melanoma called desmoplastic melanoma.
  • The cancer is located in a place that’s hard to treat with surgery, such as the eyelids, tip of the nose or ears.
  • The cancer was not responsive to drug therapy and involves limited areas.
  • The cancer has spread to high risk areas such as the brain.

Targeted Therapy or Immunotherapy for Melanoma

Targeted therapy and Immunotherapy represent new and highly effective ways to treat melanoma.

Targeted therapies block specific pathways in the tumors that are driven by genetic changes or mutations in the DNA. The most common example is where a melanoma tumor harbors a mutation in the BRAF gene. This occurs in about half of melanoma cases arising from the skin. Therapies that block the activated BRAF pathway, also known as BRAF and MEK inhibitors, can significantly reduce the recurrence risk in patients with surgically removed high risk melanoma and can produce responses in the majority patients with active BRAF mutant melanoma.  Targeted therapies are given as pills on a continuous basis.

Immunotherapies work to stimulate immune responses directed against the tumor cells to clear the cancer. Older immunotherapies such as interferon and interleukin-2 have been used in patients to reduce recurrence risk and to treat patients with active disease. While long-term responses were seen in select patients, these agents are associated with a range of serious side effects due to off target effects. Newer immunotherapy strategies target specific checkpoints in the immune system, which activate T-cells or reinvigorate exhausted T-cells to eliminate tumors. The main class of therapy is called immune checkpoint inhibitors (ICI), which include antibody therapy that blocks PD-1 and CTLA-4 on immune cells. Anti-PD-1 therapy can be use alone or in combination with anti-CTLA-4 therapy to lower the recurrence risk in patients with surgically removed high risk melanoma, as well as produce durable responses in patients with active melanoma.  Approximately 2/3 of responses with ICI are durable, and many responding patients can eventually be monitored off active treatment. While these therapies generally are well tolerated, auto-immune type side effects can occur. These can require prompt management by experienced providers. ICI is given as an intravenous infusion every 2-6 weeks.

Long-term survival (>5 years) can be achieved in patients with advanced melanoma treated with either BRAF targeted therapy or ICI therapy. However, not every patient will have a durable response and will need alternative options. New immunotherapy strategies have demonstrated clinical activity in patients whose cancer has progressed on standard targeted therapy and immunotherapy strategies. These are largely available only on clinical trials at this time. One of the more promising immunotherapy strategies is adoptive T-cell therapy as known as tumor infiltrating lymphocyte (TIL) therapy. This requires a patient’s tumor to be removed, the T-cells in the tumor (TIL) expanded in the laboratory, and then reinfused back into the patient. Patients first receive chemotherapy prior to the TIL infusion and then interleukin-2 afterwards. Medstar Georgetown University Hospital / Lombardi Comprehensive Cancer Center is the only regional DC center offering this therapy outside of the National Cancer Institute. 

Chemotherapy for Melanoma

Melanoma is often resistant to chemotherapy, and targeted therapy and immunotherapy are usually better choices when the disease has advanced. But chemotherapy can help relieve symptoms or extend survival for some patients and may be a good option in patients whose cancer progress on targeted therapy and immunotherapy.

Melanoma Follow-Up Care

Your physician will want to see you every three to six months following your treatment if there are no signs of active cancer. You may need to repeat any of the diagnostic tests to make sure the cancer is not returning.

Malignant melanoma can return after treatment. To protect yourself from a recurrence, you should:

  • Stay out of the sun, especially during the hottest hours of the day
  • Always protect your body from the sun with hats, long sleeves, sunglasses and sunscreen
  • Regularly check your skin for new or changing moles or other marks

Stan Sher's Journey with Advanced Melanoma and Immunotherapy

Make an Appointment

For more information or to schedule an appointment with a melanoma specialist, call our scheduling line: 

202-444-2223


Melanoma Specialists Team

Medical Oncology

Surgical Oncology

Dermatology

Dermatopathology

Radiation Oncology

Reconstructive Surgery

Find a melanoma specialist or skin cancer expert at MedStar Georgetown to meet your individual treatment needs.

Find a melanoma specialist or skin cancer expert at MedStar Georgetown to meet your individual treatment needs.


Awards & Recognition

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The Georgetown Lombardi Comprehensive Cancer Center is the only National Cancer Institute (NCI)-designated comprehensive cancer center in the Washington, D.C. region.


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