Melanoma is a type of cancer that starts in the cells that give your skin color. These cells are called melanocytes. At stage 3, your cancer has spread to your lymph nodes. It may have spread to other parts of your body from there.

Treatment for melanoma aims to stop the cancer before it can spread any further. Surgery to remove the cancer, and possibly the lymph nodes around it, is usually the first step. Sometimes surgery can remove all of the cancer, but sometimes it can’t.

A high-risk melanoma is more likely to return after surgery. These cancers are very deep or thick (more than 4 millimeters), and they have spread to the lymph nodes. This makes it hard for a surgeon to remove them entirely.

Any stray cancer cells left behind could start to grow again. Adjuvant therapy can prevent your cancer from returning and help you live longer.

Adjuvant therapy is an extra treatment you get after surgery to lower the chance that your cancer will come back. Adjuvant therapy for stage 3 melanoma often includes immunotherapy. These drugs stimulate your immune system to attack the cancer cells.

Immunotherapy treatments for stage 3 melanoma include the following FDA-approved options:

  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)
  • ipilimumab (Yervoy)
  • combination of nivolumab and ipilimumab
  • aldesleukin (Proleukin)
  • interferon alfa-2b (Intron A)
  • peginterferon alfa-2b (Sylatron/PEG-Intron)

The first three drugs listed above are known as checkpoint inhibitors. They release the brakes on your immune system by blocking proteins on the surface of immune cells that would normally stop them from attacking the cancer.

Yervoy targets a protein called cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Keytruda and Opdivo target the programmed cell death protein 1 (PD-1). By blocking these proteins, the drugs activate your immune system to attack the cancer.

Dabrafenib (Tafinlar) plus trametinib (Mekinist) is another type of adjuvant treatment called targeted therapy. It works on melanomas that have changes to the BRAF gene. The gene change leads to the production of a protein that helps the cancer grow.

Adjuvant therapy might also include radiation therapy or a clinical trial for a new drug. Here are seven things to know before you start on one of these treatments.

This treatment can have side effects, some of which may be serious. Your doctor will carefully consider whether you need adjuvant therapy based on the risk of your cancer returning after surgery.

Your doctor will also base the decision to use adjuvant therapy on factors like:

  • your age
  • your overall health
  • any other medical conditions you have
  • your personal preferences

All of the immunotherapy medications come as an infusion. During each one, you’ll have to sit for 30 to 90 minutes as the drug goes into your body through a thin tube. Tafinlar and Mekinist are the only adjuvant medications that come in pill form.

Expect to stay on your treatments long-term. Depending on the type of drug you take, you’ll get immunotherapy every 2 to 4 weeks. Your treatment can last from a few months up to 3 years. You’ll keep taking it until your cancer returns or the side effects become too much for you to tolerate.

Adjuvant treatments use strong drugs, which can cause side effects. Some of the most common ones are:

  • tiredness
  • rash
  • itching
  • nausea
  • diarrhea
  • fever
  • headache
  • cough
  • muscle pain

These drugs can also cause more serious complications like:

  • inflammation of the lungs (pneumonitis)
  • inflammation of the colon (colitis)
  • liver or kidney disease
  • thyroid problems
  • inflammation of the brain (encephalitis)

Your doctor can tell you which side effects you’re most likely to have from the medication you take.

Sometimes adjuvant treatments work better together. For example, doctors sometimes combine Yervoy and Opdivo if one drug isn’t effective enough.

Radiation isn’t typically used as a first-line treatment for melanoma, but it’s sometimes used for adjuvant therapy. Radiation aims high-intensity X-ray beams at the tumor. Your doctor may give you this treatment after surgery to get rid of any cancer cells left behind.

Researchers are always studying new drugs and combinations of medications to treat melanoma in the form of human clinical trials. If the treatment you’re on isn’t working for you, joining one of these studies may be an option.

A research trial will give you access to treatments that are not yet available to the public. The medication you try could be more effective than the ones currently available.

Ask the doctor who treats your melanoma if any studies are available in your area that you may be eligible for. If you join a trial, make sure you understand how the drug might help your cancer and what side effects it could cause.

Surgery is an effective treatment for stage 3 melanoma, but adjuvant therapy is like an extra insurance policy. Getting additional treatment after your surgery may lower the risk of your cancer coming back. Adjuvant therapy could potentially delay a relapse, prolong your life, and possibly cure your cancer.