The first 60 days: Stage IIB and IIC melanoma
Stage IIB and IIC melanomas are thick or ulcerated skin melanomas that have not reached the lymph nodes but still carry a real risk of coming back. A year of pembrolizumab or nivolumab after surgery lowers that risk, though most people in this group would have been cured by surgery alone, so the decision weighs a modest benefit against a year of treatment. Below, week by week, is what OnCo's record of Stage IIB and IIC melanoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Wide local excision with margins set by thickness and sentinel lymph node biopsy for primaries over 0.8 mm or with ulceration.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Diagnosis and surgery.
- RadiologistNamed in the standard of care for: Surveillance.
- SurgeonNamed in the standard of care for: Diagnosis and surgery.
- Medical oncologistNamed in the standard of care for: Adjuvant, stage IIB or IIC, Adjuvant vaccine (emerging).
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
One year of pembrolizumab (KEYNOTE-716) or nivolumab (CheckMate 76K), or observation after a shared decision about a modest benefit and immune side effects.
Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001, which included stage IIB and IIC; regulatory review pending.
Skin and nodal examination and, for higher-risk disease, imaging at intervals; patient education on self-examination.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Breslow thickness, Ulceration of the primary, Sentinel lymph node status, Mitotic rate, BRAF V600 mutation), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Stage IIB, Stage IIC, Stage IIA.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Diagnosis and surgery
- For my situation (diagnosis and surgery), which of the standard options do you recommend and 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.
Adjuvant, stage IIB or IIC
- For my situation (adjuvant, stage iib or iic), which of the standard options do you recommend and 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.
- Am I a candidate for Pembrolizumab, Nivolumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- 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?Trial populations differ from individual patients; ask how closely you match.
Adjuvant vaccine (emerging)
- For my situation (adjuvant vaccine (emerging)), which of the standard options do you recommend and why?Guideline options include: Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001, which included stage IIB and IIC; regulatory review pending.
- Am I a candidate for Intismeran autogene, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of INTerpath-001 (V940-001) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Surveillance
- For my situation (surveillance), which of the standard options do you recommend and why?Guideline options include: Skin and nodal examination and, for higher-risk disease, imaging at intervals; patient education on self-examination.
Any stage
- Are there clinical trials I could join, for example of INTerpath-001 (V940-001), Intismeran autogene, Adjuvant Encorafenib and Binimetinib in High-risk Stage II Melanoma With a BRAF Mutation., ctDNA-guided adjuvant therapy in stage II-III melanoma?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?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?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Roughly four in five patients would have been cured by surgery alone and cannot yet be told apart from the fifth”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “No overall survival benefit has yet been shown for adjuvant therapy in stage II”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Adjuvant Encorafenib and Binimetinib in High-risk Stage II Melanoma With a BRAF Mutation.Phase 3 · active · NCT05270044Adjuvant Encorafenib & Binimetinib vs. Placebo in Fully Resected Stage IIB/C BRAF V600E/K Mutated Melanoma: a Randomized Triple-blind Phase III Study in Collaboration With the EORTC Melanoma Group
- Effectiveness Study of Nivolumab Compared to Placebo in Prevention of Recurrent Melanoma After Complete Resection of Stage IIB/C MelanomaPhase 3 · active · NCT04099251A Phase 3, Randomized, Double-Blind Study of Adjuvant Immunotherapy With Nivolumab Versus Placebo After Complete Resection of Stage IIB/C Melanoma
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Stage IIB and IIC melanoma: the full pageStage IIB and IIC melanomas are thick or ulcerated skin melanomas that have not reached the lymph nodes but still carry a real risk of coming back. A year of pembrolizumab or nivolumab after surgery lowers that risk, though most people in this group would have been cured by surgery alone, so the decision weighs a modest benefit against a year of treatment.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Breslow thickness: How deep a melanoma has grown into the skin, in millimetres.
- Ulceration (melanoma): Loss of the skin surface over a melanoma under the microscope; a sign of aggressive biology that raises the stage.
- Wide local excision: Cutting out a tumour together with a measured rim of normal-looking tissue around it, so that microscopic spread at the edge is removed too.
- Circulating tumour DNA (ctDNA): Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.
- Neoadjuvant / adjuvant / perioperative: Neoadjuvant therapy is treatment given before surgery, adjuvant therapy is treatment given after it, and perioperative therapy is both.
Every term links to the glossary.