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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
Stage II melanoma is node-negative disease staged by Breslow thickness and ulceration: IIB is a 2 to 4 millimetre ulcerated or a thicker non-ulcerated primary, IIC a primary over 4 millimetres with ulceration. Sentinel node biopsy defines the stage; if it is negative, treatment was for decades surgery alone with surveillance, since adjuvant interferon added little. Yet relapse and death rates for IIB and IIC exceed those of IIIA, and because stage II is so much commoner than stage III it contributes more melanoma deaths in absolute numbers.
KEYNOTE-716 (2021) randomised 976 patients with resected IIB or IIC disease to a year of pembrolizumab or placebo and improved twelve-month recurrence-free survival from 83.1 to 90.5 percent (hazard ratio 0.65), with distant metastasis-free survival also improved and the benefit sustained at five years; pembrolizumab was approved for this stage in December 2021. CheckMate 76K (2023) found the same with nivolumab (twelve-month recurrence-free survival 89.0 against 79.4 percent, hazard ratio 0.42), approved in October 2023. INTerpath-001 (2026), which included stage IIB and IIC, met its endpoints for intismeran autogene added to pembrolizumab.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis and surgery | Wide local excision with margins set by thickness and sentinel lymph node biopsy for primaries over 0.8 mm or with ulceration. | not mapped |
| Adjuvant, stage IIB or IIC | One year of pembrolizumab (KEYNOTE-716) or nivolumab (CheckMate 76K), or observation after a shared decision about a modest benefit and immune side effects. | not mapped |
| Adjuvant vaccine (emerging) | Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001, which included stage IIB and IIC; regulatory review pending. | not mapped |
| Surveillance | Skin and nodal examination and, for higher-risk disease, imaging at intervals; patient education on self-examination. | not mapped |