The Johns Hopkins Melanoma Program offers a broad range of expertise in the use of medication to treat patients with melanoma. In addition to offering the highest level of standard care, our Melanoma Program specialists collaborate with other Johns Hopkins scientists, national cooperative groups, the National Cancer Institute and international consortia in developing and conducting studies of experimental therapies. Read more about this work in our Research section and our Clinical Trials section.

Treatments for patients with early-stage melanoma

The standard of care for individuals with early-stage melanoma is surgery and, in some cases, this may be all the treatment that is needed. However, many patients require close monitoring, as melanomas can reappear after surgery. Recent research has shown that medical treatment following surgery – so-called adjuvant therapy – can be beneficial in preventing or delaying the recurrence of melanoma. The medical oncologists in the Johns Hopkins Melanoma Program are experts in administering a variety of FDA-approved adjuvant therapies to patients when appropriate.

Our melanoma oncologists collaborate with dermatologists, surgeons and other medical experts to consider the specific features of each case to provide the most up-to-date treatment and monitoring plans.

Treatments for Patients with Advanced Melanoma

A melanoma is called “advanced” when it has spread beyond the original site to multiple other areas of the skin, nearby lymph nodes or other parts of the body, including internal organs. In these cases, patients typically require medical rather than surgical therapy. The number of treatment options for patients with advanced melanoma has dramatically increased over the past decade. The members of the Johns Hopkins Melanoma Program have played leadership roles in the development of many of these therapies. Treatment options fall into three broad categories, as follows:

Immunotherapy

Immunotherapy works by activating the body’s immune system to fight cancer. Researchers at Johns Hopkins Kimmel Cancer Center have led the way in developing a variety of immunotherapies targeting critical pathways in melanoma and other cancers (PD-1, PD-L1, CTLA-4, LAG-3). Each of the immunotherapies for melanoma listed below is administered by our team of experts to ensure safety and maximum efficacy.

• Pembrolizumab (Keytruda) or Nivolumab (Opdivo)
• Combination Ipilimumab (Yervoy) + Nivolumab
• T-VEC: a virus-based therapy that is injected into a melanoma tumor
• High-dose Interleukin-2 (IL-2)
  • Johns Hopkins is among a select few Comprehensive Cancer Centers in the Mid-Atlantic region equipped to give IL-2 therapy. Johns Hopkins patients are treated in private rooms in our comprehensive cancer center, under the watchful eye of expert physicians and specially trained oncology nurses.

Targeted Therapy

Some melanomas contain genetic mutations that help the tumor grow. The most common of these mutations, occurring in the BRAF, cKIT and NRAS genes, can be targeted with specific medications to slow the growth of melanoma. The medical oncologists in the Johns Hopkins Melanoma Program have expertise in the comprehensive genetic testing of melanoma tumors and the administration and management of targeted therapies in an individualized “precision medicine” approach. Such therapies may include the following:

• Dabrafenib (Tafinlar) + Trametinib (Mekinist)
• Encorafenib (Braftovi) + Binimetinib (Mektovi)
• Vemurafenib (Zelboraf) + Cobimetinib (Cotellic)
• Our melanoma oncology team is also experienced in combining immunotherapies with targeted therapies, including the FDA-approved combination of atezolizumab (anti-PD-L1, Tecentriq) with Vemurafenib and Cobimetinib for patients with BRAF-mutant melanoma.

Some melanomas contain more rare mutations for which personalized targeted therapy may be appropriate. In these cases, we collaborate with a multidisciplinary panel of scientific experts who can help guide treatment recommendations tailored to the genetics of individual patients.

Chemotherapy

Although now less commonly used in patients with advanced melanoma, the medical oncologists in the Johns Hopkins Melanoma Program remain experienced with standard-of-care chemotherapy options, which can provide benefits in specific cases. These chemotherapies include:

• Temozolomide - an oral chemotherapy taken daily for five days each month
• Dacarbazine - an intravenous drug administered every three weeks in an outpatient clinic
• Carboplatin and Taxol - two intravenous drugs administered weekly in an outpatient clinic

Clinical Trials

Our melanoma specialists also lead and participate in clinical trials of new immunotherapies, targeted therapies and other investigational therapies for patients with early and advanced melanoma. Please see our Clinical Trials section for more information.

Supportive Care and Additional Resources

We strongly believe that the treatment of individuals with melanoma (or any cancer) should go beyond treating the impact of cancer on the body alone. Cancer care at the Johns Hopkins Sidney Kimmel Comprehensive Cancer includes access to world-class experts in the fields of among others palliative care, nutrition and psychological well-being to ensure that you receive the most comprehensive care possible.

Melanoma in Young People

Johns Hopkins Expertise

Faculty in the Johns Hopkins Melanoma Program have expertise in melanoma among children, teenagers and young adults. They have authored several editorial articles and recently completed one of the largest review studies of outcomes in young melanoma patients. Results of this pivotal study are forthcoming.

Information You Need to Know

Melanoma is extremely rare among children younger than 10. Melanoma is unusual, although not rare, in teenagers and increases in incidence with increasing age. Children at higher risk for developing melanoma may have freckles, tan poorly, have a family history of melanoma or have an increased number of moles. The prognosis depends on tumor thickness and stage of disease.

Follow-Up Care

Follow-up care of melanoma patients should be tailored to an individual patient’s needs. Patients with Stages I, II, and III disease should receive lifelong dermatologic screening since these patients are at higher risk for developing another primary skin cancer, either melanoma or other type, such as basal cell or squamous cell carcinomas. Your care team will discuss how often you should be screened for skin cancers.

For those with in situ melanoma or very thin melanomas with a low risk of recurrence, follow-up only with a dermatologist or primary care provider for skin evaluations may be appropriate. For those with intermediate or thick melanomas, or melanomas that have spread to lymph nodes, follow-up evaluation with a medical and/or surgical oncologist is generally recommended. It is important to note that most melanoma recurrences are detected by patients between exams. We encourage melanoma patients to report new or unusual changes.

For more information regarding patient treatment guidelines and follow-up care, please visit the National Comprehensive Cancer Network website.