The Landmark Series: Melanoma and Adjuvant Therapy

Despite the increase in the number of new melanomas diagnosed annually, melanoma death rates have consistently decreased. This is in large part owing to improved systemic therapies that have shown a dramatic improvement in both progression-free and melanoma-specific survival for patients with advanced melanoma. Given the improvement in outcomes for patients with unresectable and metastatic disease, immune checkpoint blockade¹ and BRAF-targeted therapies² were subsequently tested in patients with resectable melanoma. These improvements in outcomes support consolidative, aggressive surgery in selected patients; the role of surgical intervention continues to evolve with the advent of these therapies. While therapeutic lymphadenectomy remains integral to the treatment approach for patients with regional disease, a considerable number of patients experience recurrence after surgery alone. This review will highlight the impact of systemic therapies on the reduction of recurrences following curative intent surgery. Arguably, no aspect of the care of patients with melanoma has seen a greater impact of landmark trials in the past decade than considerations for adjuvant therapy. …