Loading
Stage III melanoma has spread to nearby lymph nodes but not further, and after surgery a year of immunotherapy, or of targeted pills if the cancer has a BRAF mutation, roughly halves the chance of it coming back. The newest trials show that giving immunotherapy before the operation instead of after works even better and lets most people stop treatment early.
Stage III melanoma is defined by regional nodal, satellite or in-transit disease and is staged by primary thickness and ulceration together with the number and size of nodal deposits. MSLT-II (2017) showed that removing the whole nodal basin after a positive sentinel node does not improve melanoma-specific survival, so most patients now keep their nodes and are watched with ultrasound. For decades the only adjuvant drug was high-dose interferon alfa, with a small relapse-free benefit and heavy toxicity; adjuvant ipilimumab (EORTC 18071, 2015) improved survival but at the cost of frequent severe immune toxicity.
CheckMate 238 (2017) showed nivolumab beat ipilimumab for recurrence-free survival (70.5 against 60.8 percent at one year) with a third of the serious toxicity, and KEYNOTE-054 (2018) showed pembrolizumab beat placebo (75.4 against 61.0 percent at one year, 55.4 against 38.3 percent at five years). COMBI-AD (2017) showed a year of dabrafenib-trametinib halved relapse risk in BRAF-mutant disease (ten-year relapse-free survival 48 against 32 percent). Adding ipilimumab to nivolumab (CheckMate 915) or relatlimab to nivolumab (RELATIVITY-098) after surgery added nothing, so a year of single-agent anti-PD-1 antibody, or the BRAF-MEK doublet, became the adjuvant standard.
The neoadjuvant trials then changed the timing. SWOG S1801 (2022) moved three of eighteen pembrolizumab doses to before surgery and improved two-year event-free survival from 49 to 72 percent with the same total drug. NADINA (2024) gave two cycles of ipilimumab plus nivolumab before surgery and adjuvant therapy only to poor responders, and cut events by two thirds against adjuvant nivolumab (twelve-month event-free survival 83.7 against 57.2 percent); about six in ten patients had a major pathological response and needed no further treatment. Neoadjuvant immunotherapy is now the preferred approach for macroscopic nodal disease. INTerpath-001 (2026) added the personalised mRNA vaccine intismeran autogene to adjuvant pembrolizumab and met its recurrence-free survival endpoint in resected stage IIB to IV disease, confirming the phase 2b KEYNOTE-942 signal (eighteen-month recurrence-free survival 78.6 against 62.2 percent).
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Each skin cancer comes from a different cell layer: melanocytes and basal cells at the base of the epidermis, keratinocytes above them, Merkel cells and blood vessels in the dermis; depth of invasion decides the risk.
Same organ: Melanoma, Basal cell carcinoma, Cutaneous squamous cell carcinoma, Merkel cell carcinoma, Kaposi sarcoma, Skin cancer (all types), BRAF V600-mutant melanoma, Stage IIB and IIC melanoma, Advanced melanoma (unresectable stage III and stage IV), Mucosal melanoma, Acral melanoma, Advanced cutaneous squamous cell carcinoma, Locally advanced and metastatic basal cell carcinoma, Bowen's disease (squamous cell carcinoma in situ), Dermatofibrosarcoma protuberans
Wide local excision, no completion lymph node dissection (MSLT-II), nodal ultrasound surveillance, then adjuvant systemic therapy.
Neoadjuvant ipilimumab plus nivolumab for two cycles then surgery, with adjuvant therapy only if the pathological response is poor (NADINA); or neoadjuvant then adjuvant pembrolizumab (SWOG S1801).
One year of nivolumab (CheckMate 238) or pembrolizumab (KEYNOTE-054); dabrafenib-trametinib for one year is the alternative in BRAF V600-mutant disease (COMBI-AD).
Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001 (2026); regulatory review pending.
Excision where feasible; intralesional talimogene laherparepvec or the immunocytokine daromun before surgery; isolated limb perfusion for extensive limb disease.
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Patients with melanoma that has spread to palpable lymph nodes should now be offered immunotherapy before rather than only after surgery: two cycles of low-dose ipilimumab with nivolumab, then surgery, with the pathology result deciding whether any more treatment is needed. Most patients respond well and are spared a year of adjuvant therapy. Serious side effects are more common than with nivolumab alone, mostly endocrine, and the approach requires close coordination between oncologists, surgeons and pathologists.
Adjuvant pembrolizumab is a standard for resected stage III melanoma, with subsequent trials extending it to stage II and to the neoadjuvant setting.
Adjuvant nivolumab (or pembrolizumab) is standard for resected stage III and IV melanoma; ipilimumab is no longer used in the adjuvant setting.
Adjuvant dabrafenib-trametinib is a standard for resected stage III BRAF-mutant melanoma alongside adjuvant PD-1 blockade; the choice weighs a finite year of oral therapy against immune side effects.
Stage IIB, IIC and III on this site's melanoma pages, and the recognition that stage IIIA has a better prognosis than stage IIB or IIC, come from this system.
Patients with a positive sentinel node are now managed with surveillance and adjuvant systemic therapy rather than completion dissection.
Query for this cancer: (TITLE:"Stage III melanoma" OR ABSTRACT:"Stage III melanoma" OR TITLE:"after surgery" OR ABSTRACT:"after surgery" OR TITLE:"Resected stage III melanoma" OR ABSTRACT:"Resected stage III melanoma" OR TITLE:"Node-positive melanoma" OR ABSTRACT:"Node-positive melanoma" OR TITLE:"Regional melanoma" OR ABSTRACT:"Regional melanoma" OR TITLE:"Adjuvant melanoma setting" OR ABSTRACT:"Adjuvant melanoma setting") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Stage III melanoma (after surgery), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Dabrafenib: take on an empty stomach. Trametinib: take on an empty stomach; both cause pyrexia.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
Inflammation of the bowel caused by immunotherapy releasing the immune system against the gut lining, producing diarrhoea that can be severe. It is the commonest serious side effect of CTLA-4 antibodies and is treated with steroids and, if needed, infliximab.
See all on the product pages:Dabrafenib + trametinibIpilimumabNivolumabPembrolizumab·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Stage III melanoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.