OnCo

Sign in to keep your watchlist

Your watched pages live in this browser. Sign in with an email link and OnCo keeps the same list on every device you use. Only your email address and your watchlist are stored.

Living with cancer·Standard of care

Stage IIB and IIC melanoma: the decisions you may face

Cancer page →Second-opinion finder →

4 treatment settings, 2 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

One path named

Wide local excision with margins set by thickness and sentinel lymph node biopsy for primaries over 0.8 mm or with ulceration.

Guideline
NCCN Guidelines: Melanoma: Cutaneous
The path, in plain words
Sentinel lymph node biopsyStandard of care

Removing just the first lymph node a tumour drains to, instead of all of them, to check for spread.

  • Avoids lymphoedema from full dissection
Also referenced:Wide local excisionBreslow thickness
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Sentinel lymph node biopsy
  • False negatives in ~5-10%
Questions to ask about this decision
  1. Is Sentinel lymph node biopsy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Melanoma: Cutaneous), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (diagnosis and surgery), which of the standard options do you recommend and why?
    Why: Guideline options include: Wide local excision with margins set by thickness and sentinel lymph node biopsy for primaries over 0.8 mm or with ulceration.

Add these to your appointment list, or take the full question set for this cancer.

Early / localised

Adjuvant, stage IIB or IIC

2 optionsCompare side by side →

One year of pembrolizumab (KEYNOTE-716) or nivolumab (CheckMate 76K), or observation after a shared decision about a modest benefit and immune side effects.

Guideline
NCCN Guidelines: Melanoma: Cutaneous
The options, in plain words
PembrolizumabApprovedMonoclonal antibody (anti-PD-1)

Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.

NivolumabApprovedMonoclonal antibody (anti-PD-1)

Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.

The evidence behind it
The main trade-offs on record
Pembrolizumaball recorded rates →
Side effectAny gradeGrade 3+
Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients8%-
Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients3.4%-
Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients1.7%-
Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients0.7%-
  • No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Nivolumaball recorded rates →
Side effectAny gradeGrade 3+
Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated25%14.4%
Hepatitis with ipilimumab · Monotherapy pooled unless stated15%13.4%
Colitis · Monotherapy pooled unless stated2.9%1.7%
Hepatitis · Monotherapy pooled unless stated1.8%1.5%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision
  1. Between Pembrolizumab and Nivolumab, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in KEYNOTE-716 and Effectiveness Study of Nivolumab Compared to Placebo in Prevention of Recurrent Melanoma After Complete Resection of Stage IIB/C Melanoma, and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. Which side effects of Pembrolizumab or Nivolumab are most likely for me, which are reversible, and which would make us stop?
    Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
  5. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  6. Does your recommendation follow the current guideline (NCCN Guidelines: Melanoma: Cutaneous), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  7. For my situation (adjuvant, stage iib or iic), which of the standard options do you recommend and why?
    Why: Guideline options include: One year of pembrolizumab (KEYNOTE-716) or nivolumab (CheckMate 76K), or observation after a shared decision about a modest benefit and immune side effects.
  8. 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.
  9. How do the results of KEYNOTE-716 and Effectiveness Study of Nivolumab Compared to Placebo in Prevention of Recurrent Melanoma After Complete Resection of Stage IIB/C Melanoma apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Early / localised

Adjuvant vaccine (emerging)

One path named

Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001, which included stage IIB and IIC; regulatory review pending.

The path, in plain words
Intismeran autogenePhase 3Personalised mRNA neoantigen vaccine

A custom mRNA vaccine encoding up to 34 of a patient's own tumour mutations. In August 2026 it became the first personalised cancer vaccine to win a phase 3 trial.

The evidence behind it
The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision
  1. Is Intismeran autogene the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in INTerpath-001 (V940-001), and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  5. For my situation (adjuvant vaccine (emerging)), which of the standard options do you recommend and why?
    Why: Guideline options include: Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001, which included stage IIB and IIC; regulatory review pending.
  6. Am I a candidate for Intismeran autogene, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  7. How do the results of INTerpath-001 (V940-001) apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

2 options

Skin and nodal examination and, for higher-risk disease, imaging at intervals; patient education on self-examination.

Guideline
NCCN Guidelines: Melanoma: Cutaneous
The options, in plain words
Skin cancer screening (visual skin examination)Emerging

Checking the whole skin for suspicious moles finds melanomas earlier, but no trial has yet shown that screening everyone saves lives, so most countries target people at high risk.

  • Cheap and non-invasive
  • Melanoma is highly curable when thin
Dermoscopy, total-body photography & AI skin analysisEstablished

Magnified skin imaging and whole-body photo mapping, increasingly read by algorithms, to find melanoma early and avoid unnecessary biopsies.

  • Cheap, non-invasive, repeatable
  • Reduces benign excisions when used well
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Skin cancer screening (visual skin examination)
  • No randomised trial of mortality benefit
  • Rising melanoma incidence without matching mortality change points to overdiagnosis
  • Performance varies by skin tone and training
Dermoscopy, total-body photography & AI skin analysis
  • Algorithm performance drops on darker skin and rare subtypes
  • No proven mortality benefit for population screening
Questions to ask about this decision
  1. Between Skin cancer screening (visual skin examination) and Dermoscopy, total-body photography & AI skin analysis, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Melanoma: Cutaneous), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (surveillance), which of the standard options do you recommend and why?
    Why: Guideline options include: Skin and nodal examination and, for higher-risk disease, imaging at intervals; patient education on self-examination.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.