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Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells. It is not often used to treat melanoma skin cancer.

When might radiation therapy be used?

Radiation therapy is not needed for most people with melanoma on the skin, although it might be useful in certain situations:

• Radiation might be an option to treat some early-stage melanomas, if surgery can’t be done for some reason.
• Radiation might be used after surgery (as an adjuvant treatment) in some situations if there’s a high risk that the melanoma might come back. For example, it’s often used after surgery for an uncommon type of melanoma known as desmoplastic melanoma, which has a higher risk of recurring after surgery alone.
• Sometimes, adjuvant radiation is given after surgery in the area where lymph nodes were removed, especially if many of the nodes contained cancer cells. This is to try to lower the chance that the cancer will come back.
• Radiation might be used to treat melanoma that has come back after surgery, either in the skin or lymph nodes, or to help treat distant spread of the disease.
• Radiation therapy can be used to relieve symptoms caused by the spread of melanoma to other parts of the body, especially to the brain or bones. Treatment with the goal of relieving symptoms is called palliative therapy. Palliative radiation therapy is not expected to cure the cancer, but it might help shrink it or slow its growth for a time to help control some of the symptoms.

How is radiation therapy given?

The type of radiation most often used to treat melanoma, known as external beam radiation therapy, focuses radiation from a source outside of the body on the cancer.

Before treatments start, your radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session is called simulation.

The treatment schedule can vary based on the goal of treatment and where the melanoma is.

The treatment itself is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer.

Stereotactic radiosurgery (SRS)

SRS is a type of radiation therapy that can sometimes be used for tumors that have spread to the brain. (Despite the name, there is no actual surgery.) High doses of radiation are aimed precisely at the tumor(s) in one or more treatment sessions. There are 2 main ways to give SRS:

• In one version, a machine called a Gamma Knife focuses about 200 thin beams of radiation on the tumor from different angles over a few minutes to hours. The head is kept in the same position by placing it in a rigid frame.
• In another version, a linear accelerator (a machine that creates radiation) that is controlled by a computer moves around the head to deliver thin beams of radiation to the tumor from many different angles over a few minutes. The head is kept in place with a head frame or a plastic face mask.

These treatments can be repeated if needed.

Stereotactic body radiation therapy (SBRT)

This approach is similar to SRS (using a linear accelerator), but it can be used to treat tumors in other parts of the body, such as the lungs or spine.

Possible side effects of radiation therapy

Side effects of radiation are usually limited to the area getting radiation. Common side effects can include:

• Sunburn-like skin problems
• Changes in skin color
• Hair loss where the radiation enters the body
• Fatigue
• Nausea (if radiation is aimed at the abdomen)

Often these side effects go away after treatment.

Radiation therapy to the brain can sometimes cause memory loss, headaches, trouble thinking, or reduced sexual desire. Usually, these symptoms are minor compared with those caused by a tumor in the brain, but they might still affect a person’s quality of life.