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Back to the Melanoma hub →40 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

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Decisions you may face

8 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Stage II-III3 Metastatic first line2 After PD-13 Screening and diagnosis Stage I-II primary2 Stage IIB-IIC (thick or ulcerated, node-negative)2 Resectable stage III (macroscopic nodes)Stage III after surgery (adjuvant)Unresectable or metastatic, first line BRAF V600-mutant, after immunotherapy or needing rapid response4 After anti-PD-1 failure3 Metastatic uveal melanoma (HLA-A*02:01-positive)Brain metastases3

Red cards

From the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Fainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Binimetinib Cobimetinib Dabrafenib + trametinib Encorafenib Vemurafenib source
Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Ipilimumab Nivolumab Pembrolizumab Relatlimab + nivolumab source
Emergency services now
Cytokine release syndrome
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
Brenetafusp Tebentafusp source
Check before combining
Encorafenib with Vemurafenib: major interaction
QT: both Encorafenib and Vemurafenib prolong the QT interval (known and known risk).. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
Encorafenib Vemurafenib source
Check before combining
Food and drink: Dabrafenib + trametinib
Dabrafenib: take on an empty stomach. Trametinib: take on an empty stomach; both cause pyrexia.
Dabrafenib + trametinib source
Check before combining
Food and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Pembrolizumab source

See all on the product pages:Binimetinib Brenetafusp Cobimetinib Dabrafenib + trametinib Encorafenib Ipilimumab Nivolumab Pembrolizumab Relatlimab + nivolumab Tebentafusp Vemurafenib·Printable cards in the navigator

Treatment journeys

What the next twelve months look like, phase by phase, with the decision points.

Stage III (node-positive)

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Melanoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 40 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example BRAF V600, NRAS, KIT, PD-L1, TMB), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Superficial spreading, Nodular, Lentigo maligna.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Stage II-III

For my situation (stage ii-iii), which of the standard options do you recommend and why?
Why: Guideline options include: Adjuvant pembrolizumab/nivolumab; neoadjuvant IO for resectable stage III.
Am I a candidate for Pembrolizumab, Nivolumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Metastatic first line

For my situation (metastatic first line), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab-ipilimumab or nivolumab-relatlimab; BRAF/MEK if rapid control needed.
Am I a candidate for Relatlimab + nivolumab, Encorafenib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of CheckMate 067 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

After PD-1

For my situation (after pd-1), which of the standard options do you recommend and why?
Why: Guideline options include: Lifileucel, RP1 + nivolumab, ipilimumab-based, trials; tebentafusp (uveal).
Am I a candidate for Lifileucel, Vusolimogene oderparepvec, Tebentafusp, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Screening and diagnosis

For my situation (screening and diagnosis), which of the standard options do you recommend and why?
Why: Guideline options include: Dermoscopy, total-body photography for high-risk patients, excisional biopsy with Breslow thickness and ulceration reported; AI decision support emerging.

Stage I-II primary

For my situation (stage i-ii primary), which of the standard options do you recommend and why?
Why: Guideline options include: Wide local excision with margins by thickness (1-2 cm); sentinel lymph node biopsy from ~0.8 mm Breslow or with ulceration; nodal ultrasound surveillance rather than completion dissection if positive (MSLT-II).
How do the results of MSLT-II apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Stage IIB-IIC (thick or ulcerated, node-negative)

For my situation (stage iib-iic (thick or ulcerated, node-negative)), which of the standard options do you recommend and why?
Why: Guideline options include: Adjuvant pembrolizumab or nivolumab for one year (KEYNOTE-716, CheckMate 76K); discuss modest absolute benefit and irAE risk; ctDNA-guided trials.
Am I a candidate for Pembrolizumab, Nivolumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of KEYNOTE-716 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Resectable stage III (macroscopic nodes)

For my situation (resectable stage iii (macroscopic nodes)), which of the standard options do you recommend and why?
Why: Guideline options include: Neoadjuvant ipilimumab + nivolumab (two cycles) then surgery with response-adapted adjuvant therapy (NADINA), or neoadjuvant pembrolizumab (SWOG S1801); alternative adjuvant-only PD-1 or, if BRAF-mutant, dabrafenib-trametinib.
How do the results of NADINA and SWOG S1801 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Stage III after surgery (adjuvant)

For my situation (stage iii after surgery (adjuvant)), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab or pembrolizumab for one year; dabrafenib-trametinib for BRAF V600 (COMBI-AD, 10-year RFS 48%); relatlimab adds nothing (RELATIVITY-098).
Am I a candidate for Dabrafenib + trametinib, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of COMBI-AD and RELATIVITY-098 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Unresectable or metastatic, first line

For my situation (unresectable or metastatic, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab + ipilimumab (highest long-term survival; ~59% grade 3-4 events) or nivolumab + relatlimab (Opdualag; ~21%) or anti-PD-1 alone; for BRAF-mutant disease, immunotherapy first (DREAMseq) unless rapid control is needed.
How do the results of CheckMate 067 and RELATIVITY-047 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

BRAF V600-mutant, after immunotherapy or needing rapid response

For my situation (braf v600-mutant, after immunotherapy or needing rapid response), which of the standard options do you recommend and why?
Why: Guideline options include: BRAF + MEK doublet: encorafenib-binimetinib, dabrafenib-trametinib, or vemurafenib-cobimetinib; triplet with atezolizumab is approved but little used.
Am I a candidate for Encorafenib, Binimetinib, Vemurafenib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of COLUMBUS apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

After anti-PD-1 failure

For my situation (after anti-pd-1 failure), which of the standard options do you recommend and why?
Why: Guideline options include: Lifileucel TIL therapy (accelerated approval 2024), RP1 oncolytic virus + nivolumab (2026), ipilimumab-based rechallenge, brenetafusp trials; clinical trials strongly encouraged.
Am I a candidate for Lifileucel, Vusolimogene oderparepvec, Brenetafusp, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of C-144-01 and PRISM-MEL-301 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Metastatic uveal melanoma (HLA-A*02:01-positive)

For my situation (metastatic uveal melanoma (hla-a*02:01-positive)), which of the standard options do you recommend and why?
Why: Guideline options include: Tebentafusp (OS benefit, IMCgp100-202); liver-directed therapy for hepatic-dominant disease; ipilimumab-nivolumab has modest activity.
Am I a candidate for Tebentafusp, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of IMCgp100-202 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Brain metastases

For my situation (brain metastases), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab + ipilimumab for asymptomatic disease (~50% intracranial response, CheckMate 204); stereotactic radiosurgery; BRAF/MEK for symptomatic BRAF-mutant disease.
Am I a candidate for Nivolumab, Ipilimumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Any stage

Are there clinical trials I could join, for example of Intismeran autogene, Vusolimogene oderparepvec, Lifileucel, Tebentafusp?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “Primary IO resistance in ~40%”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Uveal and mucosal subtypes”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

Newly diagnosed? Read the first 60 days with Melanoma, then print the one-page appointment sheet with room for the answers.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Model panel1 model

Machine commentary by named AI models on a date, not clinical review. Claims are tied to the record's own sources; check them before relying on anything here.

FableAnthropic · v5.12026-09-17low confidence

The record's account of melanoma biology, UV-driven risk, surgical cure of early disease and the arrival of checkpoint blockade, BRAF inhibition and the first oncolytic virus is consistent with the Wikipedia source. Its most quantitative claims cannot be checked: the 330,000 annual case figure, the ten-year survival numbers, the toxicity percentages and the NCCN category labels all rely on a guideline landing page or on linked records rather than on the two listed sources, and the tldr's 'half live 10 years' sits awkwardly beside the summary's own 'melanoma-specific survival' qualifier. The 2026 approvals and the intismeran phase 3 result are unsourced within the record. Prevention is absent despite UV being named as the main cause. Editorially, the history has duplicated 2011, 2014, 2015, 2024 and 2026 entries, biomarkers list BRAF V600 and HLA-A*02:01 twice, and standardOfCare has overlapping metastatic first-line and post-PD-1 settings that should be merged.

Right 3Missing 1Unclear 4Show verdicts

Right
Most cases are cured by excision when found early, and it is the skin cancer most likely to spread when it is not.
Wikipedia describes melanoma as the most dangerous type of skin cancer, with surgical removal the mainstay for localised disease and outcomes strongly dependent on early detection. Consistent with the record.
Wikipedia
Right
Risk is driven by ultraviolet exposure and fair skin.
Wikipedia lists ultraviolet light exposure and low skin pigmentation among the primary causes and risk factors, matching the record's framing.
Wikipedia
Unclear
Melanoma causes about 330,000 cases per year, and incidence is rising in fair-skinned populations.
Wikipedia supports rising incidence in populations of European descent, but the annual case count on the Wikipedia page derives from an earlier global estimate and does not settle the 330,000 figure. The record gives no year or registry for the number.
Wikipedia
Unclear
Half of advanced patients now live 10 years.
The tldr states this as survival, but the record's own summary qualifies the ~50% CheckMate 067 figure as melanoma-specific survival, which is not the same as the proportion alive at ten years. Neither listed source resolves the figure; the tldr should carry the same qualifier as the summary.
Wikipedia
Unclear
Neoadjuvant immunotherapy is the new standard for resectable stage III disease; NCCN 'Preferred (neoadjuvant IO)'.
The NCCN link is a guideline landing page and the record does not state a version or date, so the specific category labels (Preferred, 1, 2A) attached to the standard-of-care entries cannot be checked from the listed sources.
NCCN Guidelines: Melanoma: Cutaneous (Stage II-III)
Right
Also the first with an approved TIL therapy, an oncolytic virus.
Wikipedia records talimogene laherparepvec as the first oncolytic virus approved, in 2015, for melanoma, which backs the oncolytic virus half of the claim. The record elsewhere uses the narrower wording 'first TIL therapy' for lifileucel, which is safer than the stateOfArt phrasing 'first cell therapy for a solid tumour', a broader claim the listed sources do not settle.
Wikipedia
Unclear
Intismeran autogene plus pembrolizumab became the first personalised mRNA vaccine to pass a phase 3 in August 2026; RP1 with nivolumab approved 2026.
These 2026 events are asserted with an asOf date of September 2026 but neither listed source is cited for them; they rest entirely on linked records. The record should point to a primary announcement or label them as pending verification.
Wikipedia
Missing
Prevention (sun protection, avoidance of sunbeds) is not covered in the record.
The record names UV exposure as the main risk driver and links a sunbed-ban idea and a prevention bottleneck, yet has no prevention entry in standardOfCare or summary. Wikipedia devotes a section to prevention through sun avoidance and protective measures.
Wikipedia

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ProvenanceLast edited 2026-09-18 · Jude Gomila · Link cancer subtypes to their siblings and name parents i… · diff · file · history

Wikipedia

Melanoma

Sources & links

Wikipedia