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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Positive sentinel node, no palpable disease | Wide local excision, no completion lymph node dissection (MSLT-II), nodal ultrasound surveillance, then adjuvant systemic therapy. | not mapped |
| Resectable macroscopic nodal disease | 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). | not mapped |
| Adjuvant, after upfront surgery | 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). | not mapped |
| Adjuvant vaccine (emerging) | Intismeran autogene with pembrolizumab met its endpoints in INTerpath-001 (2026); regulatory review pending. | not mapped |
| In-transit disease | Excision where feasible; intralesional talimogene laherparepvec or the immunocytokine daromun before surgery; isolated limb perfusion for extensive limb disease. | not mapped |