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Melanoma — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardDermatologyMelanomaABIM Board

A 58-year-old woman has undergone wide excision and negative sentinel-node biopsy for a T3bN0M0 cutaneous melanoma. Imaging shows no metastatic disease. She has ECOG performance status 0, no organ transplant and no autoimmune disease. Which postoperative systemic strategy should be discussed?

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Correct answer: C — Offer adjuvant nivolumab after discussing recurrence reduction and immune toxicity

The best answer is “Offer adjuvant nivolumab after discussing recurrence reduction and immune toxicity”. Completely resected stage IIB melanoma still carries a clinically important recurrence risk despite a negative sentinel node. Adjuvant anti-PD-1 therapy with nivolumab is an approved option and should be considered through shared decision-making that includes immune-mediated toxicity. Dacarbazine is not the contemporary adjuvant standard, BRAF-MEK treatment requires an appropriate mutation and indication, and nodal radiation does not substitute for systemic adjuvant therapy.

Reference: FDA Approval: Nivolumab for Adjuvant Stage IIB/C Melanoma: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-nivolumab-adjuvant-treatment-stage-iibc-melanoma