Cutaneous Melanoma

Authored by James Larkin, published on 2026-03-24 03:17:44.0

Cutaneous Melanoma treatment algorithm by Breslow thickness and stage.

  1. <0.8mm Breslow thickness
    • Excise and Dermatology FU
  2. >0.8mm Breslow thickness
    • Excise and discuss SNB
      • >1mm SN burden: US surveillance and discuss adjuvant systemic Rx: D+T (if BRAF mutant) vs anti-PD1
      • <1mm SN burden: US surveillance and Dermatology FU
  3. Palpable Stage 3 melanoma
    • Discuss neoadjuvant / adjuvant pembro or nivo3 + ipi1
  4. Stage 4 melanoma / unresectable Stage 3
    • Discuss nivo1 + ipi3 or nivo + rela; anti-PD1 monotherapy only if not suitable for combination
      • Lifileucel if suitable; if BRAF mutant then BRAF targeted therapy can be considered before or after
  5. Stage 4 NED
    • Discuss anti-PD1 monotherapy, nivo/rela and nivo1 + ipi3
      • Lifileucel if suitable; if BRAF mutant then BRAF targeted therapy can be considered before or after
  6. For T2b and higher node negative tumors (Stage IIB, IIC), consider adjuvant anti-PD1
tosprivacy