[Adjuvant and neoadjuvant treatments of melanoma]

The management of melanoma has evolved significantly over the past decade with the advent of immunotherapies and BRAF/MEK inhibitors, which have changed the prognosis for patients with advanced disease. Having demonstrated their efficacy in advanced disease, these treatments have been evaluated and shown to be effective in adjuvant treatment at earlier stages, first in stage III and then in stage IIB-IIC. Alongside the development of these adjuvant treatments, which have become the standard of care, new therapeutic strategies have emerged. Neoadjuvant treatments have been shown to be superior to adjuvant treatments in phase II and III trials. These neoadjuvant strategies will undoubtedly become the new standard for patients with macroscopic lymph node disease. However, there are still many unanswered questions regarding the optimal treatment regimen. Should mono- or bi-immunotherapy be used? Can surgery be de-escalated? Is additional adjuvant treatment essential or can it be withheld in the event of a major pathological response? Should patients with BRAFV600 mutations switch to targeted therapies in the event of pathological non-response? Should we switch to targeted therapies in the event of pathological non-response in BRAFV600 mutant patients? Therapeutic strategies, which are becoming increasingly personalised, are evolving very rapidly, with a trend towards de-escalation. We still lack robust biomarkers for patient selection.