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Melanoma — SCE Dermatology MCQ

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HardSkin CancerMelanomaSCE Dermatology

A 75-year-old man with resected stage IIB melanoma (pT3b N0) has undergone wide local excision and sentinel lymph node biopsy (negative). According to current guidelines, what adjuvant systemic therapy should be discussed?

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Correct answer: E — Adjuvant Pembrolizumab or Nivolumab (anti-PD-1 therapy)

Based on the KEYNOTE-716 (Pembrolizumab) and CheckMate 76K (Nivolumab) trials, adjuvant anti-PD-1 therapy significantly improves recurrence-free survival in resected stage IIB/IIC melanoma. NICE has approved adjuvant Nivolumab and Pembrolizumab for resected high-risk stage II melanoma. Stage IIB/IIC melanomas have recurrence rates comparable to stage IIIA/IIIB disease, justifying adjuvant therapy. The decision should involve shared decision-making regarding benefits (RFS improvement) versus risks (immune-related adverse events including permanent endocrinopathies). Interferon-alpha is no longer standard.

Reference: NICE TA684 2021 Pembrolizumab adjuvant; CheckMate 76K 2023