Systemic Therapy for Melanoma: What Surgeons Need to Know

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.