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Melanoma Adjuvant — SCE Dermatology MCQ

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ModerateSkin CancerMelanoma AdjuvantSCE Dermatology

A 65-year-old man with a melanoma has positive SLNB with a 2.5 mm deposit. His dermatologist discusses adjuvant therapy options. He has a BRAF V600E mutation. What are his adjuvant therapy options?

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Correct answer: C — Adjuvant anti-PD-1 (Nivolumab or Pembrolizumab) OR adjuvant BRAF/MEK targeted therapy (Dabrafenib + Trametinib) — patient choice informed by efficacy/toxicity profiles

For BRAF V600E-mutant stage III melanoma, two adjuvant options exist: (1) Anti-PD-1 immunotherapy (Nivolumab — CheckMate 238; Pembrolizumab — KEYNOTE-054) which improves RFS/DMFS regardless of BRAF status; (2) Combined BRAF/MEK targeted therapy (Dabrafenib + Trametinib — COMBI-AD) which also improves RFS. The choice involves shared decision-making considering: fixed duration treatment (12 months for both), side effect profiles (immunotherapy: risk of permanent endocrinopathies; targeted therapy: pyrexia, rash), and long-term outcome data. For BRAF wild-type patients, only anti-PD-1 immunotherapy is available. NICE approves both pathways.

Reference: NICE TA684/TA558/TA396; BAD 2017 Melanoma