Appointment sheet
Stage III melanoma (after surgery)
Prepared with OnCo (onco.cc/prep/stage-iii-melanoma/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
23 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.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?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Positive sentinel node, no palpable disease
- 5.For my situation (positive sentinel node, no palpable disease), which of the standard options do you recommend and why?
- 6.How do the results of MSLT-II apply to someone like me?
Resectable macroscopic nodal disease
- 7.For my situation (resectable macroscopic nodal disease), which of the standard options do you recommend and why?
- 8.Am I a candidate for Nivolumab, Ipilimumab, Pembrolizumab, and what side effects should I expect?
- 9.How do the results of NADINA and SWOG S1801 apply to someone like me?
Adjuvant, after upfront surgery
- 10.For my situation (adjuvant, after upfront surgery), which of the standard options do you recommend and why?
- 11.Am I a candidate for Nivolumab, Pembrolizumab, Dabrafenib + trametinib, and what side effects should I expect?
- 12.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?
Adjuvant vaccine (emerging)
- 13.For my situation (adjuvant vaccine (emerging)), which of the standard options do you recommend and why?
- 14.Am I a candidate for Intismeran autogene, and what side effects should I expect?
- 15.How do the results of INTerpath-001 (V940-001) apply to someone like me?
In-transit disease
- 16.For my situation (in-transit disease), which of the standard options do you recommend and why?
- 17.Am I a candidate for Talimogene laherparepvec, and what side effects should I expect?
- 18.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?
Any stage
- 19.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)?
- 20.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 21.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 22.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?
- 23.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?
The words I may hear
- 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.
Tests and results to bring
Biomarker results to ask for: Sentinel node status and nodal tumour burden, Breslow thickness and ulceration of the primary, BRAF V600 mutation (adjuvant targeted therapy option), Pathological response after neoadjuvant immunotherapy (major pathological response guides omission of adjuvant therapy), Circulating tumour DNA after surgery (trials of adjuvant selection), Interferon-gamma gene signature (exploratory predictor in NADINA).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Resectable macroscopic nodal disease: 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). (NADINA, SWOG S1801, Nivolumab, Ipilimumab, Pembrolizumab, Major pathological response (MPR))
- Adjuvant, after upfront surgery: 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). (CheckMate 238, Study of Pembrolizumab (MK-3475) Versus Placebo After Complete Resection of High-Risk Stage III Melanoma (MK-3475-054/1325-MG/KEYNOTE-054), COMBI-AD, Nivolumab, Pembrolizumab, Dabrafenib + trametinib)
- Adjuvant vaccine (emerging): Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001 (2026); regulatory review pending. (INTerpath-001 (V940-001), Intismeran autogene, Personalised neoantigen (mRNA) vaccines)
- Positive sentinel node, no palpable disease: Wide local excision, no completion lymph node dissection (MSLT-II), nodal ultrasound surveillance, then adjuvant systemic therapy. (MSLT-II, Sentinel lymph node biopsy, Wide local excision)
- In-transit disease: Excision where feasible; intralesional talimogene laherparepvec or the immunocytokine daromun before surgery; isolated limb perfusion for extensive limb disease. (Talimogene laherparepvec, Neoadjuvant L19IL2/L19TNF- Pivotal Study, Efficacy of Daromun Neoadjuvant Intratumoral Treatment in Clinical Stage IIIB/C/D Melanoma Patients, Isolated limb perfusion and infusion, Electrochemotherapy)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call