ENMelanoma is where modern immunotherapy first proved itself, so the conversation differs from most other cancers. The drug does not target the tumour cell: it releases a brake on the patient’s own T lymphocytes, and the immune system does the rest.
This page covers skin melanoma immunotherapy in Germany: the drugs, treatment after surgery versus treatment of metastases, what is done when immunity attacks healthy organs, course length, and how it differs from targeted therapy for BRAF mutations. General principles: cancer immunotherapy in Germany.
What the brake is: mechanism and drug groups
The brake is a pair of proteins on T lymphocytes, PD-1 and CTLA-4, which a tumour can press to switch the attack off. Drugs blocking them, called checkpoint inhibitors, stop the tumour pressing the brake, so lymphocytes see their target again. The treatment targets the immune response, not the tumour.
Melanoma treatment uses PD-1 blockers (nivolumab, pembrolizumab), a CTLA-4 blocker (ipilimumab), a LAG-3 blocker (relatlimab, only with nivolumab) and two-drug combinations. Combinations act more strongly and cause side effects more often, so one drug or two is always about benefit versus tolerability, not stronger meaning better.
Immunotherapy took hold in melanoma because the tumour carries many genetic changes, hence many proteins the body reads as foreign, making it easier for the immune system to recognise. Mucosal and eye melanoma behave differently; that is a separate conversation with the doctor.
When it is given: after surgery and in metastatic disease
It is given after surgery or for metastases. After the tumour and affected lymph nodes are removed it is called adjuvant: no disease is visible, the drug lowers the risk of return, and the course is time-limited, usually a year.
In advanced, metastatic disease the aim is to hold growth back, and treatment continues while it works and is tolerated.
For bulky nodes, treatment before surgery (neoadjuvant) is also possible; German centres discuss it in the tumour board, including within clinical trials. The aim is a smaller operation and a microscopic check, after removal, of whether the tumour responded.
The decision rests on stage and primary tumour thickness in the pathology report, lymph nodes, site and number of metastases, BRAF status, general condition and existing illnesses, above all autoimmune disease and past transplants. In Germany a tumour board, not one doctor, decides: see melanoma treatment in Germany on stages, melanoma surgery in Germany on removing tumour and nodes.
What the pathology report and mutation testing decide
Both decide which treatment is possible at all: before the first drop of any drug, a document governs everything. It must state the melanoma type, Breslow thickness (depth of growth), ulceration, excision margins and lymph nodes; advanced disease adds BRAF testing and immunohistochemical stains for tumour proteins.
BRAF matters because it shapes the choice. With the mutation there are two roads, immunotherapy or targeted drugs (BRAF and MEK inhibitors), and their order is discussed separately; without it, that targeted road does not exist and the question answers itself.
Imaging before the start usually covers the whole body and, separately, the brain, as brain metastases change the urgency and make-up of treatment. Tissue from an earlier biopsy at home usually suffices: the paraffin block is sent to Germany. On the stains: tumour immunohistochemistry in Germany.
Side effects and how they are managed
These side effects differ in nature from chemotherapy’s, as an unleashed immune system can hit healthy organs: the skin (rash, itching), bowel (diarrhoea, colitis), thyroid and other endocrine glands (such as the pituitary), the liver, and less often lungs, kidneys and heart. Fatigue is common; unlike with chemotherapy, hair usually does not fall out.
Speed matters: these reactions are manageable if caught early and dangerous if left. So before a course, patients get a card with the on-call number and signs that mean calling at once rather than waiting for the next appointment. Treatment usually means pausing the drug and giving steroids, sometimes permanent hormone replacement if the thyroid is affected.
Monitoring follows a schedule: blood tests, thyroid hormones and other values before each infusion, examination, repeat imaging at set intervals. Response is not judged on the first scan: an immune response sometimes first looks like a growing lesion. Overview in German: German Cancer Research Centre information service.
How a course works for a patient from another country
The drug is given intravenously in a day unit; the infusion takes from half an hour, the gaps between infusions two to six weeks, and the gaps, not the drip, decide how long a person stays in Germany.
Real options: work-up and start in Germany, then home treatment under your own oncologist on the German plan; travelling for each infusion; or staying throughout. Which works depends on whether the drug is available at home and whether the local doctor will manage side effects.
Papers in hand must give drug name and dose, interval, monitoring plan, signs that mean urgent help, and a contact at the German hospital. On the estimate: cost of immunotherapy in Germany.
Frequently asked questions
How long does melanoma immunotherapy last?
After surgery, usually one year; with metastases, as long as the drug works and is tolerated, without a preset end date. How much of that time is spent in Germany depends on the intervals between infusions and on where the course continues.
Can melanoma immunotherapy continue at home?
Yes, if the drug is available in the patient’s country and the local oncologist will manage side effects. Work-up and start then take place in Germany, later infusions at home under a written German plan: drug, dose, interval, checks, warning signs.
Does hair fall out during melanoma immunotherapy?
Usually not: hair loss is typical of chemotherapy, not checkpoint inhibitors. Their side effects are inflammation of the skin, bowel, liver, thyroid or other organs. These are manageable if treated early, so report a new rash, diarrhoea or sudden weakness at once.
How AlenMed arranges melanoma immunotherapy in Germany
We collect the pathology report, imaging and discharge letters, pass them to oncologists at partner hospitals that treat melanoma regularly, and get their view on what fits this case and what they advise against, before any figure is named. Then: a written plan, estimate, visa invitation, interpreter at appointments, accommodation between infusions.
Plan for how many days the first trip takes, who answers a question a month after you return home, and how tolerability data reach the German doctor. Guide figures: cancer treatment prices in Germany; the exact sum comes from the estimate.
This is reference material, not an offer; a doctor decides the indication and regimen at an in-person consultation.
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