For Australians facing advanced melanoma or certain other skin cancers, immunotherapy advances have changed what treatment can achieve. Medicines that help the immune system recognise and attack cancer have given many people options that were not available a generation ago. But they do not replace prevention, prompt diagnosis or surgery for early disease. A suspicious spot still needs a clinical assessment without delay.

Australia has one of the world’s highest rates of skin cancer. That makes treatment progress deeply significant, but it also makes a clear message essential: the best outcome usually begins with finding skin cancer early, when treatment may be simpler and more effective.

What immunotherapy does

Your immune system constantly looks for abnormal cells, including cancer cells. Cancer can sometimes avoid this surveillance by using natural immune “brakes” that stop T cells – a type of white blood cell – from attacking too strongly.

Checkpoint inhibitor immunotherapies release some of these brakes. In melanoma, drugs targeting the PD-1 pathway, and in selected circumstances drugs targeting CTLA-4, can help the immune system mount a stronger response against cancer. These treatments are given by a specialist cancer team, usually as an infusion at a hospital or treatment centre.

Immunotherapy is different from chemotherapy. Chemotherapy directly damages rapidly dividing cells. Immunotherapy works through the body’s own immune response. That distinction matters because the benefits, timing and side effects are different.

Immunotherapy advances are changing treatment pathways

The biggest change is that immunotherapy is no longer considered only when melanoma has spread widely. For some people with high-risk melanoma removed by surgery, immunotherapy may be recommended afterwards to reduce the chance of the cancer returning. This is called adjuvant treatment.

For unresectable stage III melanoma or stage IV melanoma, immunotherapy can shrink or control cancer for a prolonged period in some patients. Responses vary. Some people have an excellent and durable response; others do not respond, or their cancer responds for a time before progressing. Your treatment team will consider the stage of cancer, where it has spread, previous treatments, other health conditions and tumour testing when discussing options.

Combination immunotherapy, using more than one medicine, can produce stronger responses for some people with advanced melanoma. The trade-off is a higher risk of serious immune-related side effects. For that reason, a combination is not automatically the right choice for every patient. The decision needs a careful conversation between the patient, their family where appropriate, and an experienced multidisciplinary team.

Researchers are also studying ways to better match treatment to the individual cancer. This includes blood tests and tumour features that may help predict response, new combinations with targeted therapies, and treatment approaches given before surgery in selected high-risk cases. These are promising developments, but not every approach is suitable, funded or available outside a clinical trial.

Beyond melanoma

Immunotherapy also has a role in some non-melanoma skin cancers. Advanced cutaneous squamous cell carcinoma may be treated with PD-1 immunotherapy when surgery or radiation is not appropriate. Some advanced basal cell carcinomas may also be eligible for immunotherapy after other treatments have not worked or cannot be used.

These cases are less common than early basal cell and squamous cell cancers, which are often treated successfully with surgery or other local treatments. Still, the availability of systemic treatment matters for people with complex, recurrent or advanced disease. It is another reason not to ignore a lesion that bleeds, crusts, grows, becomes painful or fails to heal.

Benefits must be weighed against immune-related side effects

Because immunotherapy activates immune activity, the immune system can sometimes inflame healthy organs as well as cancer. Side effects can occur during treatment or, less commonly, after treatment has finished. They can affect almost any part of the body.

Common symptoms may include fatigue, rash, itch, diarrhoea, nausea or joint aches. More serious inflammation can involve the bowel, lungs, liver, kidneys, hormone-producing glands, heart or nervous system. New shortness of breath, persistent diarrhoea, severe abdominal pain, yellowing of the skin or eyes, a severe headache, confusion, significant weakness or a widespread blistering rash requires urgent medical advice.

Do not try to push through concerning symptoms or treat them with over-the-counter medicines without checking first. Early reporting allows a treating team to investigate promptly and, where needed, pause treatment or prescribe medicines such as corticosteroids to calm the immune response. Every minute counts when severe side effects are developing.

People with autoimmune conditions, organ transplants, chronic infections or significant lung, liver or bowel disease need particularly individualised advice. Immunotherapy may still be possible in some circumstances, but the risk-benefit balance can be more complicated.

What immunotherapy cannot do

Treatment advances should never create false reassurance about skin checks. Immunotherapy is generally not used for an ordinary suspicious mole before it has been diagnosed. It is not a substitute for sunscreen, protective clothing, shade, or avoiding deliberate tanning. Nor does it mean every advanced skin cancer can be cured.

Early detection remains one of the most powerful tools in skin cancer care. A melanoma found before it has spread can often be treated with surgery alone. Basal cell carcinomas and squamous cell carcinomas are also commonly managed effectively when identified early. Waiting to see whether a spot disappears can turn a straightforward procedure into a more complex treatment pathway.

Check skin you can see, but remember that melanoma can occur in less obvious places: the scalp, between toes, under nails, on the soles of feet and in the eye. People with darker skin can still develop skin cancer, often in areas that receive less sun exposure. A partner, friend or hairdresser may notice a changing spot on the scalp or back before you do.

When to book a skin check

Arrange a skin check with a GP, dermatologist or qualified skin cancer clinician if you notice a new or changing mole, a spot that looks different from others, or a sore that does not heal. Changes in asymmetry, border, colour, diameter or evolution are useful warning signs, but not every concerning lesion follows a textbook pattern.

People at higher risk should be especially proactive. This includes those with a personal or family history of melanoma, many moles, fair skin that burns easily, a history of severe sunburn, regular occupational sun exposure, immune suppression, or previous skin cancers. Outdoor workers, surfers, gardeners, tradies and anyone spending long periods in high-UV conditions should make skin checks part of routine health care.

If a biopsy confirms skin cancer, ask your treating clinician what type it is, how deep or advanced it is, whether it has been fully removed, and whether referral to a specialist team is needed. If immunotherapy is being discussed, ask about the goal of treatment, likely benefits, possible side effects, alternatives, treatment costs and what symptoms require an urgent call.

Immunotherapy offers real hope for many Australians with advanced skin cancer. The practical step you can take today is simpler: if a spot is new, changing or not healing, book a professional skin check. Knowledge can save your life, and timely assessment gives you the widest range of options.