Melanoma Radiotherapy

Radiation therapy (also known as radiotherapy) is used for skin cancer in the various stages of the disease, either as the sole therapy or together with surgery and system therapy/immunotherapy/targeted therapy as postoperative treatment, to achieve a cure for the disease (curative radiotherapy).


Radiation can also be used if the skin cancer has already spread. Radiotherapy can then prevent or alleviate symptoms caused by metastases, e.g. in the bones(palliative radiotherapy).

Radiation therapy is performed as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can thus be easily integrated into everyday private and professional life. Radiotherapy focuses high-energy X-rays on the tumor to kill it in a targeted manner. In the case of skin cancer, however, fractionated treatment over 4-5 weeks is usually necessary. Depending on the type and stage of the tumor, the location of the body and the patient’s general condition, radiotherapy may be necessary 2, 3 or 5 times a week. Close and personal support is a matter of course for us. Palliative treatment to alleviate symptoms or treat metastases, on the other hand, can be significantly shorter depending on the situation and may only last for 1-10 sessions.

The Department of Radiation Oncology at the USZ uses only the most modern techniques for the precise irradiation of skin tumors and offshoots with few side effects. Standard techniques in our clinic include intensity-modulated radiotherapy (IMRT) and the technical advancement VMAT (volumetric modulated arc therapy), “fast” high-energy electrons, high-dose-rate (HDR) brachytherapy, and image-guided adjustment and irradiation (IGRT). They are supervised by internationally recognized experts in the research and treatment of skin cancer.

For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working to improve the treatment of malignant melanoma in order to make it even more effective and tolerable. To the overview of currently open studies.

In the following, we will describe radiation therapy for the different stages of melanoma.

Postoperative treatment

In the case of localized melanoma, surgical removal of the tumour is always necessary. Depending on the type and extent of the cancer, as well as possible involvement of lymph glands or nerves, or incomplete removal despite successful surgery, there is sometimes a very high risk of relapse (a so-called recurrence). In such cases, postoperative (“adjuvant”) radiotherapy significantly helps to eliminate microscopic tumor remnants, reduce the risk of recurrence and thus increase the chances of recovery.

  • Barker CA, Lee NY. Radiation therapy for cutaneous melanoma. Dermatol Clin. 2012 Jul;30(3):525-33. doi: 10.1016/j.det.2012.04.011. Epub 2012 Jun 7. PMID: 22800556; PMCID: PMC4667364.
  • Michielin O, van Akkooi A, Lorigan P, Ascierto PA, Dummer R, Robert C, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Keilholz U. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020 Nov;31(11):1449-1461. doi: 10.1016/j.annonc.2020.07.005. Epub 2020 Aug 4. PMID: 32763452.

Primary, definitive treatment (without surgery) - Locoregionally advanced/ inoperable tumors

In the case of advanced tumors, surgery may not be technically feasible or would be associated with major restrictions in terms of cosmetics, function and quality of life. In these cases, and in order not to lose cosmetically and functionally important organs and structures such as eyes, ears and nerves, primary, definitive radiotherapy is the treatment of choice.

Targeted and state-of-the-art radiation planning and treatment, such as with high-energy electrons or HDR brachytherapy, ensures that healthy tissue is very well protected. This enables us to minimize the side effects of treatment in these cases. In addition, we can also reach deeper tumor extensions with these methods, which is not possible with low-energy X-rays or superficial application of medication.

The individualized treatment of various skin tumors, based on histological and biological characteristics, is a research focus of PD Dr. Balermpas and the Clinics for Dermatology and Radiation Oncology at the USZ.

  • Robinson M, Primiero C, Guitera P, Hong A, Scolyer RA, Stretch JR, Strutton G, Thompson JF, Soyer HP. Evidence-Based Clinical Practice Guidelines for the Management of Patients with Lentigo Maligna. 2020;236(2):111-116. doi: 10.1159/000502470. Epub 2019 Oct 22. PMID: 31639788.

Treatment of metastases

Skin tumors can sometimes form metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lungs, liver, bones, brain and distant lymph nodes. Brain metastases are now treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. There are also cases in which a tumor that has previously been successfully operated on or irradiated returns locally, which is known as a recurrence. Radiotherapy is a highly effective method for preventing or treating symptoms caused by metastases or recurrences. This is usually done in combination with chemotherapy, immunotherapy or another targeted therapy.

  • Schaule, Jana et al. “Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy: Melanoma brain metastases prognostic score.” Radiation oncology (London, England) 15.1 135. 1 Jun. 2020, doi:10.1186/s13014-020-01558-8
  • Stera S, Balermpas P, Blanck O, Wolff R, Wurster S, Baumann R, Szücs M, Loutfi-Krauss B, Wilhelm ML, Seifert V, Rades D, Rödel C, Dunst J, Hildebrandt G, Arnold A, Meissner M, Kähler KC. Stereotactic radiosurgery combined with immune checkpoint inhibitors or kinase inhibitors for patients with multiple brain metastases of malignant melanoma. Melanoma Res. 2019 Apr;29(2):187-195. doi: 10.1097/CMR.0000000000000542. PMID: 30802230.
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  • Ziegler JS, Kroeze S, Hilbers ML, Imhof L, Guckenberger M, Levesque MP, Dummer R, Cheng P, Mangana J. Toxicity of combined targeted therapy and concurrent radiotherapy in metastatic melanoma patients: a single-center retrospective analysis. Melanoma Res. 2020 Dec;30(6):552-561. doi: 10.1097/CMR.0000000000000682. PMID: 32658050; PMCID: PMC7643789.

Responsible professionals

Claudia Linsenmeier, Dr. med.

Attending Physician with extended responsibilites, Department of Radiation Oncology

Tel. +41 44 255 26 73
Specialties: Focus on breast/gynecology, Gastro-Intestinal Radio-Oncology, Pediatric radio-oncology

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