The first 60 days: Stage III melanoma (after surgery)
Stage III melanoma has spread to nearby lymph nodes but not further, and after surgery a year of immunotherapy, or of targeted pills if the cancer has a BRAF mutation, roughly halves the chance of it coming back. The newest trials show that giving immunotherapy before the operation instead of after works even better and lets most people stop treatment early. Below, week by week, is what OnCo's record of Stage III melanoma (after surgery) 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.
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: Resectable macroscopic nodal disease.
- RadiologistNamed in the standard of care for: Positive sentinel node, no palpable disease.
- SurgeonNamed in the standard of care for: Positive sentinel node, no palpable disease, Resectable macroscopic nodal disease, In-transit disease.
- Medical oncologistNamed in the standard of care for: Positive sentinel node, no palpable disease, Resectable macroscopic nodal disease, Adjuvant, after upfront surgery, Adjuvant vaccine (emerging) and 1 more.
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.
Neoadjuvant ipilimumab plus nivolumab for two cycles then surgery, with adjuvant therapy only if the pathological response is poor (NADINA); or neoadjuvant then adjuvant pembrolizumab (SWOG S1801).
One year of nivolumab (CheckMate 238) or pembrolizumab (KEYNOTE-054); dabrafenib-trametinib for one year is the alternative in BRAF V600-mutant disease (COMBI-AD).
Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001 (2026); regulatory review pending.
Wide local excision, no completion lymph node dissection (MSLT-II), nodal ultrasound surveillance, then adjuvant systemic therapy.
Excision where feasible; intralesional talimogene laherparepvec or the immunocytokine daromun before surgery; isolated limb perfusion for extensive limb disease.
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 Sentinel node status and nodal tumour burden, Breslow thickness and ulceration of the primary, BRAF V600 mutation, Pathological response after neoadjuvant immunotherapy, Circulating tumour DNA after surgery), 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 IIIA, Stage IIIB and IIIC, Stage IIID.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Positive sentinel node, no palpable disease
- For my situation (positive sentinel node, no palpable disease), which of the standard options do you recommend and why?Guideline options include: Wide local excision, no completion lymph node dissection (MSLT-II), nodal ultrasound surveillance, then adjuvant systemic therapy.
- How do the results of MSLT-II apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Resectable macroscopic nodal disease
- For my situation (resectable macroscopic nodal disease), which of the standard options do you recommend and why?Guideline options include: Neoadjuvant ipilimumab plus nivolumab for two cycles then surgery, with adjuvant therapy only if the pathological response is poor (NADINA); or neoadjuvant then adjuvant pembrolizumab (SWOG S1801).
- Am I a candidate for Nivolumab, Ipilimumab, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of NADINA and SWOG S1801 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Adjuvant, after upfront surgery
- For my situation (adjuvant, after upfront surgery), which of the standard options do you recommend and why?Guideline options include: One year of nivolumab (CheckMate 238) or pembrolizumab (KEYNOTE-054); dabrafenib-trametinib for one year is the alternative in BRAF V600-mutant disease (COMBI-AD).
- Am I a candidate for Nivolumab, Pembrolizumab, Dabrafenib + trametinib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CheckMate 238 and Study of Pembrolizumab (MK-3475) Versus Placebo After Complete Resection of High-Risk Stage III Melanoma (MK-3475-054/1325-MG/KEYNOTE-054) 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 (2026); 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.
In-transit disease
- For my situation (in-transit disease), which of the standard options do you recommend and why?Guideline options include: Excision where feasible; intralesional talimogene laherparepvec or the immunocytokine daromun before surgery; isolated limb perfusion for extensive limb disease.
- Am I a candidate for Talimogene laherparepvec, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Neoadjuvant L19IL2/L19TNF- Pivotal Study and Efficacy of Daromun Neoadjuvant Intratumoral Treatment in Clinical Stage IIIB/C/D Melanoma Patients apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of INTerpath-001 (V940-001), Intismeran autogene, ctDNA-guided adjuvant therapy in stage II-III melanoma, SCIB1 and iSCIB1+ in Melanoma Patients Receiving Nivolumab With Ipilimumab or SCIB1 With Pembrolizumab (The SCOPE Study)?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 “Most stage IIIA patients would never have relapsed, so a year of immunotherapy with lifelong endocrine side effects in some is given to many who do not need it”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “No biomarker yet tells who can safely skip adjuvant therapy; circulating tumour DNA trials are testing this”. 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.
- Efficacy of Daromun Neoadjuvant Intratumoral Treatment in Clinical Stage IIIB/C/D Melanoma PatientsPhase 3 · recruiting · NCT03567889An Open-Label, Randomized, Controlled Multi-Center Study of The Efficacy of Daromun (L19IL2 + L19TNF) Neoadjuvant Intratumoral Treatment Followed by Surgery and Adjuvant Therapy Versus Surgery and Adjuvant Therapy in Clinical Stage IIIB/C/D Melanoma Patients
- Neoadjuvant L19IL2/L19TNF- Pivotal StudyPhase 3 · active · NCT02938299A Pivotal Phase III, Open-label, Randomized, Controlled Multi-center Study of the Efficacy of L19IL2/L19TNF Neoadjuvant Intratumoral Treatment Followed by Surgery Versus Surgery Alone in Clinical Stage III B/C Melanoma Patients
- Study of Pembrolizumab (MK-3475) Versus Placebo After Complete Resection of High-Risk Stage III Melanoma (MK-3475-054/1325-MG/KEYNOTE-054)Phase 3 · active · NCT02362594Adjuvant Immunotherapy With Anti-PD-1 Monoclonal Antibody Pembrolizumab (MK-3475) Versus Placebo After Complete Resection of High-risk Stage III Melanoma: A Randomized, Double- Blind Phase 3 Trial of the EORTC Melanoma Group
- Phase II Trial of Neoadjuvant and Adjuvant IO102-IO103 and Pembrolizumab KEYTRUDA® in Patients With Resectable TumorsPhase 2 · recruiting · NCT05280314Phase II, Multi-cohort Trial of Neoadjuvant and Post-surgery IO102-IO103 and Pembrolizumab KEYTRUDA® in Patients With Selected Resectable Tumors
- SCIB1 and iSCIB1+ in Melanoma Patients Receiving Nivolumab With Ipilimumab or SCIB1 With Pembrolizumab (The SCOPE Study)Phase 2 · active · NCT04079166A Phase 2, Multicentre, Open-Label, Umbrella Study of SCIB1 and iSCIB1+ in Patients With Advanced Unresectable Melanoma Receiving Nivolumab With Ipilimumab or SCIB1 With Pembrolizumab (The SCOPE Study)
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 III melanoma (after surgery): the full pageStage III melanoma has spread to nearby lymph nodes but not further, and after surgery a year of immunotherapy, or of targeted pills if the cancer has a BRAF mutation, roughly halves the chance of it coming back. The newest trials show that giving immunotherapy before the operation instead of after works even better and lets most people stop treatment early.
- 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.
- Major pathological response (MPR): When, after pre-surgery treatment, the removed tumour contains little or no living cancer: 10% or less viable cells.
- 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.
- Event-free / disease-free survival (EFS, DFS, iDFS, RFS): In early-stage cancer: how long patients stay free of recurrence, progression, or death.
- 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.
- 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.