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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Updated: Apr 2, 2026

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Systemic Therapy for Melanoma: What Surgeons Need to Know.

Ashlee N Seldomridge1, Roi Weiser1, Ashley M Holder1

  • 1Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.

Surgical Oncology Clinics of North America
|May 24, 2025
PubMed
Summary

Systemic therapies like immune checkpoint inhibitors and targeted BRAF/MEK inhibitors have improved survival for stage IV melanoma patients. Surgeons need to understand these treatments and their potential immune-related adverse events (irAEs) for optimal perioperative care.

Keywords:
Immune checkpoint inhibitorsImmune-related adverse eventsIpilimumabMelanomaNivolumabPembrolizumabRelatlimabTalimogene laherparepvec

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Area of Science:

  • Oncology
  • Immunology
  • Surgical Oncology

Background:

  • Stage IV melanoma care has been revolutionized by systemic therapies.
  • Immune checkpoint inhibitors and targeted BRAF/MEK inhibitors offer improved survival rates, reaching approximately 50% at 5 years.

Purpose of the Study:

  • To review systemic therapies for cutaneous melanoma.
  • To educate surgeons on the use, toxicities, and immune-related adverse events (irAEs) of these novel treatments.
  • To discuss the impact of irAEs on surgical planning and perioperative management.

Main Methods:

  • Review of current literature on systemic therapies for cutaneous melanoma.
  • Discussion of the biology of immune checkpoint inhibition.
  • Analysis of treatment indications and toxicities associated with targeted therapies and immunotherapies.

Main Results:

  • Immune checkpoint inhibitors and BRAF/MEK inhibitors have significantly improved outcomes in stage IV melanoma.
  • These therapies can cause unique immune-related adverse events (irAEs) that require multidisciplinary management.
  • Understanding treatment toxicities is crucial for surgeons managing melanoma patients.

Conclusions:

  • Systemic therapies represent a major advancement in stage IV melanoma treatment.
  • Surgeons must be knowledgeable about these agents and their potential adverse effects.
  • Integrating knowledge of systemic therapies and their toxicities is essential for effective perioperative care in melanoma patients.