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Late Melanoma Relapse Rechallenge — SCE Medical Oncology MCQ

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HardMelanoma & SkinLate Melanoma Relapse RechallengeSCE Medical Oncology

Three years after elective nivolumab cessation following a complete response, a patient develops one biopsy-proven 3 cm melanoma liver metastasis. He is asymptomatic and has not yet had brain imaging or definitive liver assessment. What is the most appropriate next management decision?

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Correct answer: D — Complete restaging and melanoma-MDT review of local therapy with or without anti-PD-1 rechallenge

A biopsy-proven apparently solitary relapse first needs complete restaging, including brain assessment and local resectability review. The melanoma MDT can then weigh surgery or stereotactic treatment, anti-PD-1 rechallenge, or a combined sequence. Immediate systemic rechallenge may forfeit a curative local option. Surgery should not be performed without complete staging or consideration of systemic strategy. Relapse after an off-treatment interval does not automatically prove PD-1 resistance requiring combination immunotherapy. A solitary extracranial scan finding does not justify omitting brain imaging.

Reference: Retreatment after melanoma relapse following elective checkpoint-inhibitor discontinuation (Published March 2023): https://pubmed.ncbi.nlm.nih.gov/36852837/; NICE NG14 melanoma: recommendations (Updated July 2022; minor amendment January 2024): https://www.nice.org.uk/guidance/ng14/chapter/recommendations