Adjuvant and neoadjuvant treatment for melanoma: integrating immunotherapy, radiation and systemic therapies into...

Systemic therapies have transformed melanoma care, delivering durable responses and survival benefits in metastatic and resected high-risk disease. Immune checkpoint inhibitors-particularly anti-programmed death 1 agents-have replaced interferon-based regimens as the foundation of adjuvant therapy. Here, we summarize the evolution of systemic and adjuvant therapies for melanoma, with an emphasis on immune checkpoint inhibition, BRAF/MEK-targeted therapy, and emerging treatment strategies. Targeted therapies, especially BRAF/MEK inhibitors, provide rapid tumor regression and now play a defined role in metastatic and adjuvant settings for BRAF-mutant melanoma. The most exciting recent development is the discovery of neoadjuvant immunotherapy as superior to adjuvant alone in clinically detectable stage III disease, reshaping treatment algorithms and standard of care. The adjuvant landscape in melanoma has transformed care and outcomes dramatically in the last two decades and continues to evolve. Overcoming resistance and refining treatment sequencing remain key to expanding durable benefit and improving long-term outcomes.