Version May 2024
The primary treatment of patients with locoregional cutaneous melanoma is complete surgical resection. Select patients with one or a very limited number of metastases may also be candidates for surgical excision of all metastatic sites of disease. Refer to UpToDate content on surgical management of primary cutaneous melanoma and overview of the management of advanced cutaneous melanoma.
Adjuvant therapy is offered to reduce the risk of disease recurrence in patients with completely resected disease. Adjuvant therapy is typically administered for up to 12 months, or until disease progression or unacceptable toxicity during this period.
Neoadjuvant therapy is administered prior to surgery in select patients with high-risk, node-positive melanoma. The approach to neoadjuvant therapy in resectable melanoma is evolving and clinical trials are encouraged, if available.AJCC: American Joint Committee on Cancer; SLN: sentinel lymph node; TLND: total lymph node dissection; irAEs: immune-related adverse events.
* All sites of disease treated with either surgery or radiation therapy.
¶ Adjuvant nivolumab is an option for those who are unable to tolerate the potential toxicities of combination nivolumab plus ipilimumab.
Δ Surveillance is an appropriate alternative to adjuvant therapy, particularly in patients with AJCC stage IIB disease who are at lower risk for disease recurrence. This approach avoids potential risks of irAEs and preserves immunotherapy as a treatment option if their disease recurs.
◊ Microscopic disease is tumor burden detected on SLN biopsy. Macroscopic disease is clinically detected lymph nodes on imaging studies or physical exam, or visible in-transit or satellite metastases that are subsequently confirmed on pathology (eg, fine needle aspiration; incisional or excisional biopsy).
§ Immunotherapy and targeted therapy with dabrafenib plus trametinib are both effective options with different toxicity profiles. The selection of therapy is based on patient characteristics and preferences. Adjuvant immunotherapy can be offered to patients willing to accept the potential long-term toxicities for a chance at durable treatment-free survival; however, targeted therapy is also a reasonable option with overall survival benefit and generally manageable toxicities. Targeted therapy is also an alternative for those who cannot receive immunotherapy, those at risk for irAEs, and/or those who prefer the convenience of oral targeted therapy over intravenous immunotherapy, after risk-benefit discussion with the treating clinician.
¥ Alternative options include neoadjuvant nivolumab plus ipilimumab or clinical trials investigating other neoadjuvant regimens, where available. Refer to UpToDate content on adjuvant and neoadjuvant therapy for cutaneous melanonma.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
