Melanoma — SCE Dermatology MCQ

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ModerateSkin CancerMelanomaSCE Dermatology

A 55-year-old man has a Breslow 3.2 mm ulcerated melanoma excised from his back. He has a positive sentinel lymph node (micrometastasis). He is BRAF V600E wild-type. What adjuvant systemic therapy should be offered?

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

For resected stage III melanoma that is BRAF wild-type, adjuvant anti-PD-1 therapy (Nivolumab or Pembrolizumab) is the standard of care. The CheckMate 238 trial showed Nivolumab superiority over Ipilimumab, and KEYNOTE-054 demonstrated Pembrolizumab benefit versus placebo. Adjuvant Dabrafenib/Trametinib (BRAF/MEK inhibition) is only indicated for BRAF V600-mutant melanoma (COMBI-AD trial). Interferon-alpha is no longer standard due to modest benefit and significant toxicity. Dacarbazine has no role in the adjuvant setting. NICE has approved both Nivolumab and Pembrolizumab for adjuvant treatment of resected stage III melanoma.

Reference: NICE TA558 Nivolumab Adjuvant; TA684 Pembrolizumab; BAD 2017