How does the latency from the original melanoma diagnosis affect your approach to neoadjuvant therapy in a patient with clinically detectable stage III nodal recurrence, and would you treat a recurrence 15 years later differently than a more rapid recurrence?  

If the recurrence is less than 1 year from the end of prior anti-PD-1 immunotherapy treatment, that would be considered likely resistance to the therapy based on the Society for Immunotherapy of Cancer (SITC) expert consensus report on immunotherapy resistance (Kluger et al., PMID 36918224). Salvage...

Latency should not matter, as melanoma is known to exhibit this behavior. If this patient is immunotherapy-naive at the time of diagnosis of clinical stage III melanoma, then I would proceed with neoadjuvant use of immunotherapy, regardless of the time gap between diagnosis of the original melanoma ...