How we treat locoregional melanoma

Area of Science:

• Oncology
• Dermatology
• Cancer Research

Background:

• Cutaneous melanoma incidence is rising, with thicker or node-involved cases posing high relapse risks.
• Recent updates to the American Joint Committee on Cancer (AJCC) staging system include a new IIID stage.
• Traditional management of locoregional melanoma has seen shifts in surgical intervention protocols.

Purpose of the Study:

• To review current management strategies for radically resectable melanoma.
• To discuss key treatment decisions based on the latest scientific evidence.
• To highlight advancements in the adjuvant therapy for locally advanced melanoma.

Main Methods:

• Review of recent randomized trials and updated AJCC staging guidelines.
• Analysis of the impact of sentinel lymph node biopsy results on treatment decisions.
• Evaluation of the efficacy of novel adjuvant therapies in clinical trials.

Main Results:

• Completion lymph node dissection offers no overall survival benefit over observation for positive sentinel lymph nodes.
• Radical dissection is now recommended only for palpable nodal metastases.
• Adjuvant immunotherapies and BRAF/MEK inhibitor combinations significantly improve recurrence-free survival in eligible patients.

Conclusions:

• Modern melanoma management integrates evolving surgical guidelines with potent adjuvant systemic therapies.
• Immunotherapy and targeted therapy represent major advancements in preventing recurrence for high-risk melanoma patients.
• Personalized treatment approaches are crucial for optimizing outcomes in radically resectable melanoma.