NCCN Guidelines for Patients
Part 4: Overview of melanoma treatments
Order of treatments
Most people with melanoma will have more than one treatment. When and why treatments are given can be hard
to understand. Part 6 gives full details. Here, the terms that describe the order of treatments are explained.
The main treatment used to rid your body of cancer is called the primary treatment. For melanoma, surgery is
often used as primary treatment to remove the cancer from your body. Chemotherapy may be used as a primary
treatment to control cancer growth in advanced melanoma.
Neoadjuvant treatment is given before primary treatment. In melanoma, it may be used for metastatic disease to
shrink the tumor before surgery.
Adjuvant treatment is given after primary treatment to try to kill any remaining cancer cells and lower the chance
of the cancer coming back. Adjuvant treatment is commonly given for some cancers. Its use for melanoma is
questioned among doctors because of unpleasant side effects and uncertain benefits. Some doctors use adjuvant
treatment for melanoma. Others do not.
First-line treatment is the first set of treatments given. If first-line treatment fails, second-line treatment is the next
treatment or set of treatments given.
The immune system is the body’s natural defense system
against infection and disease. The immune system has
many chemicals and proteins that are made naturally in
the body. These substances can also be made in a lab
to use as immunotherapy. Immunotherapy (also called
biological therapy) is treatment that increases the activity
of your immune system. By doing so, immunotherapy
drugs improve your body’s ability to find and destroy
cancer cells. Immunotherapy may be used as adjuvant
treatment after surgery. Or, it may be used as primary
treatment for more advanced melanomas that can’t be
removed by surgery.
Depending on how the drugs are given, immunotherapy
can be used as local treatment or as systemic treatment.
Table 3 lists the immunotherapy drugs used for