My Melanoma came back — what are my options now

Understanding Your Melanoma Recurrence and Treatment Options

I'm sorry to hear your melanoma has returned. This is understandably concerning, but the good news is that there are several effective treatment approaches available. Let me help you understand what doctors typically consider when melanoma recurs.

How Doctors Approach Recurrent Melanoma

When melanoma returns, your oncology team will first determine where the cancer has come back and whether it can be surgically removed. According to the NCCN Guidelines for Patients: Melanoma (2025), this distinction is critical because it shapes your entire treatment plan.

Your doctor will likely order:

• Skin biopsy to confirm it's actually cancer recurrence
• Imaging tests to see the full extent of disease
• BRAF mutation testing (if not already done) to identify whether your cancer has a specific genetic mutation that responds to targeted drugs

Treatment Options Based on Type of Recurrence

The location of recurrence matters:

Local Satellite or In-Transit Recurrence

This means cancer has returned in the lymph vessels (tiny fluid channels) near your original melanoma scar or between the scar and your lymph nodes.

If the cancer can be surgically removed (resectable):

• Surgery with complete excision to remove all disease
• T-VEC (talimogene laherparepvec) — an intralesional therapy that uses a modified virus to kill cancer cells directly at the tumor site
• Neoadjuvant systemic therapy — immunotherapy or targeted drugs given before surgery to shrink the tumor first
• Systemic therapy — drugs that work throughout your body

If surgery isn't possible or won't remove all disease (unresectable/borderline resectable):

• Systemic therapy (immunotherapy or targeted therapy) as the preferred first approach
• T-VEC injections directly into tumors
• Isolated limb infusion/perfusion (ILI/ILP) — if cancer is confined to an arm or leg, this delivers high-dose chemotherapy directly to that limb
• Radiation therapy
• Palliative care — focused on symptom relief and quality of life

Nodal Recurrence

This means cancer has returned in your lymph nodes (bean-shaped immune structures).

Treatment typically follows similar principles: surgery when possible, combined with systemic therapy options.

Understanding Your Systemic Therapy Choices

According to NCCN Guidelines, when systemic therapy is recommended, your options generally include:

Immunotherapy (checkpoint inhibitors):

• Nivolumab (Opdivo) or Pembrolizumab (Keytruda) — these "free" your immune system to attack cancer cells
• Ipilimumab — another immunotherapy option, sometimes combined with others

Targeted Therapy:

• Dabrafenib/trametinib — if your cancer has a BRAF V600 mutation, these drugs specifically target that genetic change

After Initial Treatment

Once your cancer responds to treatment and there's no evidence of disease remaining, your doctor will likely recommend adjuvant therapy (additional treatment after the main treatment) to reduce the risk of further recurrence. Common options include:

• Nivolumab or Pembrolizumab (immunotherapy)
• Dabrafenib/trametinib (if you have BRAF mutation)
• Observation with close monitoring

Questions to Ask Your Oncology Team

To help guide your shared decision-making, consider asking:

1. Where exactly has my melanoma recurred, and can it be surgically removed?
2. Do I have a BRAF mutation, and if so, how does that change my treatment options?
3. What is the goal of treatment right now — to cure the cancer, control it, or manage symptoms?
4. Which treatment approach do you recommend for my specific situation, and why?
5. What are the potential side effects of each option, and how are they managed?
6. Are there clinical trials I should consider? (The National Cancer Institute at cancer.gov maintains a searchable database of trials)

Important Resources

The American Cancer Society and NCCN Guidelines for Patients: Melanoma provide detailed, evidence-based information. Organizations like AIM at Melanoma (AIMatMelanoma.org) and the Melanoma Research Foundation (melanoma.org) also offer patient support and educational resources.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.