Just diagnosed

If you've just been told you have melanoma, here's an orientation for the first two weeks. None of this is a substitute for your treating team. It's a starting checklist so the next conversation goes better.

Ten things to do in the first two weeks

1. Get a copy of your pathology report. Ask your dermatologist's office to send it to you. The report names the type of melanoma, depth (Breslow), ulceration status, and mitotic rate — these drive everything that follows.
2. Ask about staging workup. Depending on the depth, your team may recommend a sentinel lymph node biopsy, blood work (LDH), and imaging (CT, MRI, PET-CT) to confirm whether the melanoma has spread. Confirm what's planned and why.
3. Get copies of all records. Pathology, imaging reports, lab results. Keep them in one folder (paper or digital). You'll share these with anyone giving a second opinion.
4. Consider a second opinion at an NCI-Designated Cancer Center. For anything beyond stage 0/I, a center with a high-volume melanoma program will often confirm or refine the plan. Find one in the NCI's cancer-center directory.
5. Ask about molecular testing. For stage III and IV melanoma, BRAF and (sometimes) NRAS or KIT testing can change which treatments are options. Ask whether your tumor is being tested.
6. Ask whether a clinical trial is appropriate. Trials aren't a last resort — they're often the front line for advanced melanoma. The trial finder on this site queries ClinicalTrials.gov directly.
7. Line up support. Ask one person to come to appointments and take notes. Match with a survivor through Imerman Angels. Talk to a counselor — CancerCare offers free oncology social workers.
8. Ask about cost and financial navigation. Most cancer centers have a financial counselor on staff. Ask now, before bills arrive. NCI's guide to managing cancer costs is a good starting read.
9. Plan your questions for the next visit. Use the printable list below — tick the questions that matter to you and bring it in.
10. Take care of your mental health. A diagnosis is destabilizing. If you can't sleep, can't eat, or can't think, that's normal — and it's also worth telling your team about. Many oncology programs have psychology or psychiatry on staff.

Sources: NCI PDQ — Melanoma treatment · ASCO Cancer.Net — Melanoma · AIM at Melanoma

Genetic testing on your biopsy for prognosis

Beyond the standard pathology report and the molecular tests above (BRAF, NRAS, KIT — which guide treatment selection), there are commercial gene expression profile (GEP) tests that look at the activity of multiple genes in your biopsy specimen to estimate how the tumor is likely to behave over time. They're not part of every patient's workup, and not every melanoma center uses them, but in some cases the results can inform decisions about how aggressive surveillance and adjuvant treatment should be.

Whether one of these tests is useful for your situation is a conversation to have with your treating dermatologist or oncologist. Two patient-facing references:

These are commercial tests, not universally recommended in every guideline, and the right answer depends on your stage, pathology, and what decisions the result might actually change. Ask your provider whether it's appropriate in your case, whether it's covered by your insurance, and how the result would (or wouldn't) change the plan.

Immune checkpoint inhibitors — the mainstay for advanced melanoma

Immune checkpoint inhibitors are a class of drugs that release brakes on the immune system so it can attack the cancer. Over the last decade they have transformed the outlook for advanced melanoma and are now the first systemic option discussed for many patients with stage III/IV disease, and (in the adjuvant setting) after surgery for high-risk stage IIB+/III/resected IV melanoma.

FDA-approved checkpoint regimens used in melanoma include:

• Pembrolizumab (Keytruda) — blocks PD-1. Given as an IV infusion, typically every 3 or 6 weeks.
• Nivolumab (Opdivo) — also blocks PD-1. Given every 2 or 4 weeks.
• Ipilimumab (Yervoy) — blocks CTLA-4. Usually given as a short course of doses every 3 weeks, more often used in combination than alone.
• Nivolumab + ipilimumab — a combination of both. Higher response rates than single-agent for some patients, with more frequent and more severe side effects.
• Nivolumab + relatlimab (Opdualag) — anti-PD-1 plus anti-LAG-3, FDA-approved in 2022 for unresectable or metastatic melanoma. A different combination with a different side-effect profile than nivo+ipi.

Settings where they're used:

• Adjuvant therapy — after surgery for high-risk stage IIB/IIC, III, or fully resected IV disease, typically a year of single-agent pembrolizumab or nivolumab to lower the risk of recurrence.
• First-line treatment for advanced (unresectable stage III or IV) melanoma — choice between single-agent anti-PD-1, nivo+ipi, or nivo+relatlimab depends on tumor characteristics, organ involvement, and your overall health.
• Neoadjuvant therapy before surgery in some stage III cases — a newer area of practice with promising early results.

If your tumor has a BRAF mutation, targeted therapy (BRAF + MEK inhibitors) is also an option, either as an alternative to or in sequence with checkpoint inhibitors. Your oncologist will discuss which order makes sense for you.

What to expect day-to-day: Most checkpoint inhibitors are given as IV infusions in an outpatient infusion suite. A single infusion takes 30–90 minutes; the full appointment with labs and pre-meds is typically 2–4 hours. Many people continue working and normal activities through treatment. Side effects come from the immune system being more active and can appear weeks or months in — see the at-home side-effect guide and the urgent-symptom list on the Caregivers page.

Sources: NCI PDQ — Melanoma treatment · ASCO Cancer.Net — Melanoma: types of treatment · NCI — Immune checkpoint inhibitors. Specific regimen choice is a conversation with your oncologist; this page is education, not advice.

If first-line treatments aren't enough — TIL therapy

For advanced (stage III or IV) melanoma that has progressed after immune checkpoint inhibitors — and after a BRAF/MEK inhibitor for patients with a BRAF mutation — there is now an option called TIL therapy (tumor-infiltrating lymphocyte therapy). The first FDA-approved TIL therapy for melanoma is lifileucel (brand name Amtagvi), approved in February 2024.

How it works, in plain language: a piece of tumor is surgically removed, the patient's own immune cells (T cells) are extracted from inside that tumor and grown to large numbers in a specialized lab over several weeks, then infused back into the patient. The expanded T cells then go after the cancer wherever it is.

The treatment is intensive and is delivered only at certified centers. A typical course involves:

• A surgery to harvest tumor tissue (often an enlarged lymph node or skin metastasis)
• About 3–4 weeks while the lab grows the cells
• A hospital stay of roughly 3 weeks: a short course of lymphodepleting chemotherapy, the TIL infusion, then several doses of high-dose IL-2 (interleukin-2) to support the cells
• Several weeks of recovery from the side effects of chemo and IL-2

It is not a first-line option, and not everyone is a candidate — eligibility depends on prior treatments, organ function, and the presence of resectable tumor tissue. Whether TIL is right for you is a conversation with a melanoma specialist at a center that offers it.

Patient-facing reference: Memorial Sloan Kettering — New treatment for metastatic stage 4 melanoma: TIL immunotherapy. See also the glossary entry on TIL therapy and the trial finder for active TIL studies in melanoma.

Questions to ask your doctor

Tick the questions you want, then export a PDF to bring to your appointment. Nothing leaves this device.

Question lists adapted from NCI and ASCO Cancer.Net. They're starting points, not exhaustive — add your own.