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Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinMelanomaSCE Medical Oncology

Wide excision and sentinel-node biopsy confirm a completely resected pT4aN0 cutaneous melanoma (Breslow 5.2 mm, no ulceration), with no distant disease. BRAF status is not yet available. Which adjuvant systemic option is directly recommended by NICE for this pathological stage?

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Correct answer: D — Adjuvant pembrolizumab for completely resected stage IIB melanoma under NICE TA837

A non-ulcerated melanoma thicker than 4 mm is pT4a and, when N0M0, stage IIB. TA837 recommends adjuvant pembrolizumab after complete resection of stage IIB or IIC melanoma and does not require a BRAF mutation. BRAF-MEK adjuvant therapy requires the appropriate molecular and stage context; combined nivolumab-ipilimumab is not substituted for this resected-stage appraisal, and interferon or observation-only reasoning is outdated.

Reference: NICE TA837 pembrolizumab for adjuvant treatment of resected stage 2B or 2C melanoma (Published October 2022): https://www.nice.org.uk/guidance/ta837/chapter/1-Recommendations