Melanoma, stage III

Melanoma →

Surgery to remove the melanoma and the involved nodes, then a year of immunotherapy infusions every few weeks, or immunotherapy for six weeks before surgery, followed by scans for five years.

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Typical sequence for stage III (node-positive) disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

1. Diagnosis and staging
weeks 0-4
Excision biopsy with Breslow depth and ulceration, sentinel node biopsy or ultrasound of a palpable node, PET-CT and brain MRI for stage III, BRAF testing.
Sentinel lymph node biopsy PET/CT MRI
Source
Decision: Surgery first or immunotherapy first?
- Neoadjuvant nivolumab + ipilimumab then surgery (NADINA): better event-free survival
- Surgery then a year of adjuvant anti-PD-1 (or BRAF/MEK tablets)
2. Neoadjuvant nivolumab + ipilimumab (option)
weeks 2-8
Two 3-week cycles before surgery (NADINA); a major pathological response allows adjuvant therapy to be skipped.
NivolumabIpilimumabImmune checkpoint inhibitors
Source
Decision: Major pathological response at surgery?
- Yes: no adjuvant therapy, surveillance
- No: adjuvant anti-PD-1 (or BRAF/MEK) for a year
3. Surgery
weeks 8-11
Wide local excision and therapeutic lymph node dissection of the involved basin.
Source
4. Adjuvant immunotherapy
weeks 9-61
Pembrolizumab or nivolumab for one year (KEYNOTE-054, CheckMate 238), or dabrafenib plus trametinib tablets for a year in BRAF-mutant disease (COMBI-AD). Skipped after a major response to neoadjuvant therapy.
PembrolizumabNivolumabImmune checkpoint inhibitors
Source
5. Surveillance
from week 61, continues for years
Skin and node examination every 3-6 months, imaging every 3-12 months for 3-5 years, then yearly skin checks for life.
Source

Sources

Phase by phase

1. Diagnosis and staging

weeks 0-4

Excision biopsy with Breslow depth and ulceration, sentinel node biopsy or ultrasound of a palpable node, PET-CT and brain MRI for stage III, BRAF testing.

Sentinel lymph node biopsy PET/CT MRI

Source

Decision: Surgery first or immunotherapy first?

Neoadjuvant nivolumab + ipilimumab then surgery (NADINA): better event-free survival
Surgery then a year of adjuvant anti-PD-1 (or BRAF/MEK tablets)

2. Neoadjuvant nivolumab + ipilimumab (option)

weeks 2-8

Two 3-week cycles before surgery (NADINA); a major pathological response allows adjuvant therapy to be skipped.

NivolumabIpilimumabImmune checkpoint inhibitors

Source

Decision: Major pathological response at surgery?

Yes: no adjuvant therapy, surveillance
No: adjuvant anti-PD-1 (or BRAF/MEK) for a year

3. Surgery

weeks 8-11

Wide local excision and therapeutic lymph node dissection of the involved basin.

Source

4. Adjuvant immunotherapy

weeks 9-61

Pembrolizumab or nivolumab for one year (KEYNOTE-054, CheckMate 238), or dabrafenib plus trametinib tablets for a year in BRAF-mutant disease (COMBI-AD). Skipped after a major response to neoadjuvant therapy.

PembrolizumabNivolumabImmune checkpoint inhibitors

Source

5. Surveillance

from week 61, continues for years

Skin and node examination every 3-6 months, imaging every 3-12 months for 3-5 years, then yearly skin checks for life.

Source