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Melanoma, stage III

Melanoma →

Surgery to remove the melanoma and the involved nodes, then a year of immunotherapy infusions every few weeks, or immunotherapy for six weeks before surgery, followed by scans for five years.

03691 yr15Months from diagnosis · solid bar = shortest typical duration, hatched = up to the longest · arrow = continues for yearsPhaseDiagnosis and stagingDiagnosis and tests · 2-4 wkNeoadjuvant nivolumab + ipilimumab (o…Before surgery · 6 wkSurgerySurgery and recovery · 1-3 wkAdjuvant immunotherapyAfter surgery · 52 wkSurveillanceSurveillance · yearsSurgery first or immunotherapy first?decision 1Major pathological response at surgery?decision 2Diagnosis and testsBefore surgerySurgery and recoveryAfter surgerySurveillance
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Typical sequence for stage III (node-positive) disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

  1. 1. Diagnosis and staging
    weeks 0-4

    Excision biopsy with Breslow depth and ulceration, sentinel node biopsy or ultrasound of a palpable node, PET-CT and brain MRI for stage III, BRAF testing.

    Source
    Decision: Surgery first or immunotherapy first?
    • Neoadjuvant nivolumab + ipilimumab then surgery (NADINA): better event-free survival
    • Surgery then a year of adjuvant anti-PD-1 (or BRAF/MEK tablets)
  2. 2. Neoadjuvant nivolumab + ipilimumab (option)
    weeks 2-8

    Two 3-week cycles before surgery (NADINA); a major pathological response allows adjuvant therapy to be skipped.

    Source
    Decision: Major pathological response at surgery?
    • Yes: no adjuvant therapy, surveillance
    • No: adjuvant anti-PD-1 (or BRAF/MEK) for a year
  3. 3. Surgery
    weeks 8-11

    Wide local excision and therapeutic lymph node dissection of the involved basin.

    Source
  4. 4. Adjuvant immunotherapy
    weeks 9-61

    Pembrolizumab or nivolumab for one year (KEYNOTE-054, CheckMate 238), or dabrafenib plus trametinib tablets for a year in BRAF-mutant disease (COMBI-AD). Skipped after a major response to neoadjuvant therapy.

    Source
  5. 5. Surveillance
    from week 61, continues for years

    Skin and node examination every 3-6 months, imaging every 3-12 months for 3-5 years, then yearly skin checks for life.

    Source

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