Adjuvant treatment of resected stage II, III and IV melanoma

Adjuvant radiotherapy for patients with completely resected stage IIIB or IIIC melanoma is not routinely recommended. It may be considered in individual patients following multidisciplinary team discussion of the risk of local recurrence and the benefits and risks of adjuvant therapy, including risk of significant adverse effects.

In patients with completely resected stage IV melanoma, with or without BRAF mutation, nivolumab should be considered as adjuvant treatment.

In patients with completely resected stage III melanoma without BRAF mutation, nivolumab or pembrolizumab should be considered as adjuvant treatment.

In patients with completely resected stage III melanoma with BRAF V600 mutation nivolumab, pembrolizumab or the combination of dabrafenib and trametinib should be considered as adjuvant treatment.

In patients with completely resected stage IIB or IIC melanoma with or without BRAF mutation pembrolizumab should be considered as adjuvant treatment.

For patients with stage IIIA disease with nodal metastasis 1 mm or less in diameter, the uncertainty of the individual risk/benefit ratio should be carefully discussed with the patient before deciding whether or not to have adjuvant treatment.