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ctDNA Melanoma — SCE Medical Oncology MCQ

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HardMelanoma & SkinctDNA MelanomaSCE Medical Oncology

A patient receiving adjuvant nivolumab after resection of stage IIIC melanoma has undetectable tumour-informed ctDNA at three serial time points and normal surveillance imaging. They ask to stop at 6 months solely because the ctDNA has cleared. What is the most defensible advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Do not alter the evidence-based treatment duration solely on serial ctDNA outside a trial

Option B is correct: dynamic ctDNA monitoring is promising and prognostic but is not a validated routine stopping rule. Option C is also wrong because adjuvant treatment is not indefinite and ctDNA may carry prognostic information. Option A wrongly replaces standard surveillance. Option E invents an unsupported dose strategy. Option D overstates clinical utility and risks undertreatment.

Reference: ESMO Precision Medicine Working Group recommendations on ctDNA. https://pubmed.ncbi.nlm.nih.gov/35809752/