How do you approach patients with early stage resected melanoma (Stage IIA) for adjuvant treatment?

The current guidelines do not recommend adjuvant treatment for patients with stage I/IIA disease outside the setting of a clinical trial. Major trials including the KEYNOTE-054 and CheckMate 238 have excluded patients with early stage I/IIA disease. However, in patients with stage IIB/IIC disease adjuvant pembrolizumab showed improvement in DFS but longer follow up was required for determining the OS. A detailed discussion with the patient taking into consideration the age, risk vs benefit, and history of autoimmune disease is essential in stage IIB/IIC disease before opting for adjuvant treatment.