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Melanoma is one of the most aggressive types of skin cancer, beginning deep in the layers of the skin. Historically, treatment options were minimal once the cancer spread. But recent advancements allow us to offer patients new treatment pathways for metastatic melanoma.
There’s been a revolution in how we treat metastatic melanoma, moving away from a strictly surgical approach toward advanced cellular immunotherapy—“living drugs” that leverage each patient’s unique immune system to fight cancer.
The National Cancer Institute expects more than 100,000 people in the U.S. to be diagnosed with melanoma in 2026.
Regular skin exams by a dermatologist can help spot skin cancers early, when treatment is most effective. If you are diagnosed with melanoma that has spread, new treatments offer a chance at improved outcomes.
Advanced immunotherapy for metastatic melanoma.
T-VEC: Hijacking a virus to fight cancer.
Oncolytic virus therapy is one of the most exciting tools we have. In 2015 the Food and Drug Administration (FDA) approved an oncolytic virus therapy known as T-VEC for treatment of metastatic melanoma. It is delivered using a modified version of the herpes simplex virus and designed to infect and multiply inside cancer cells while sparing healthy cells.
Here’s how it works:
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We inject the virus directly into a melanoma tumor we can see or feel under the skin.
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The virus enters the cancer cells and begins to make copies of itself until the cancer cells burst and die.
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As those cells burst, they release proteins. This acts like a flare gun for the immune system, teaching it how to identify the cancer.
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Through a process known as the abscopal effect, the immune system learns how to find and remove melanoma tumors that have spread to other parts of the body, such as the liver or brain.
Clinical trials evaluating the treatment showed that among patients with advanced melanoma, many more people treated with T-VEC saw a decrease in the size of their skin and lymph node lesions than those treated with another method.
TIL therapy: A personalized immune security team.
Another exciting breakthrough for advanced melanoma is tumor-infiltrating lymphocyte (TIL) therapy. I describe this to patients as creating a personalized security team trained specifically to fight your unique cancer.
Your body already has immune cells called T-cells that have tried to eradicate the cancer. The trouble is, these cells usually get outnumbered by cancer. TIL therapy is how we help them win the numbers game:
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Harvest sample cells: As a surgeon, my role is to use specialized surgical techniques to remove a piece of the tumor or lymph node where the melanoma is growing.
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Lab growth: Next, we send the tissue sample to a specialized lab. There, scientists find the T-cells that were already working and grow billions more of them.
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Re-infusion: The team of T-cells cells are infused back into the patient to fight cancer cells anywhere in the body.
For many years this was an experimental treatment, but the FDA approved TIL therapy for patients with metastatic or unresectable (inoperable) melanoma in 2024. MedStar Georgetown University Hospital is the first and most experienced hospital in the Washington, D.C., region to offer TIL therapy for metastatic melanoma.
Related: Read “New Metastatic Melanoma Treatment: Breakthrough TIL Therapy Offers Hope.”
Working together to treat advanced melanoma.
They often say that when the only tool you have is a hammer, everything looks like a nail. But when it comes to cancer care, it’s especially important to carry a full tool belt.
MedStar Health does this by bringing a team of experts to every patient’s case. Every other week we gather specialists to talk through each patient’s individual details. This team includes:
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Surgical oncologists like me who specialize in skin malignancies
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Medical oncologists who have expertise in systemic treatments such as chemotherapy
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Radiation oncologists with experience in using energy to destroy cancer cells
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Pathologists who can accurately diagnose skin lesions in microscopic detail
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Dermatologists and plastic surgeons who specialize in skin reconstruction
This detailed teamwork enables us to plan the most effective strategy for each patient, reduce side effects, and improve outcomes.
Related: Read “How is Immunotherapy Used to Treat Cancer?”
Caring for the whole person.
An advanced melanoma impacts much more than just your physical health. It can affect your family, your job, and your mental well-being too.
That’s why we prioritize care for the whole person. For instance, clinical trials can provide participants with access to the latest treatments before they’re available to the public.
Some studies also provide:
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Free mental health counseling for patients and their families
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Support for children under 21 whose parent has cancer
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Help with social needs, including transportation to appointments and food security
If you or a loved one has melanoma that has returned or spread, we’re here to help. We’re committed to using the most advanced treatments to personalize your care.
