How would you approach a patient with desmoplastic melanoma (pT3N0M0) post resection for adjuvant treatment?

Dr. @Dr. First Last - Could you please clarify if there is ulceration or not? That will help us to know if this is stage IIA or IIB melanoma.

If this is pT3aN0Mo disease, then this is stage IIA melanoma and dermatology surveillance is offered. No systemic imaging for surveillance is indicated. No adjuvant therapy is indicated in the current milieu of things.

If this is pT3bN0M0 disease, then this is stage IIB melanoma. These are thick ulcerated melanoma with a risk of relapse akin to stage IIIB melanoma (~30% over 5 years). In this case, KEYNOTE 716 and CHECKMATE 76K trial data are applicable for one-year adjuvant therapy with anti-PD1 monotherapy. Hence, immunotherapy can be offered with benefit recorded in RFS, DMFS, and MSS. We include ful...