Would you continue adjuvant nivolumab or pembrolizumab in a resected stage III melanoma patient that developed local-only recurrence at the site of previous surgery?

I am presuming that the patient is experiencing an in-transit recurrence while receiving anti-PD-1 monotherapy. Whilst, the intention for anti-PD1 monotherapy in the adjuvant setting is to prevent distant relapses, an in-transit recurrence is the most difficult to treat with systemic therapy. In our...

Agree with Dr. @Dr. First Last. Local intralesional therapy like TVEC + nivo combo is the better way to go, as the alternative options with dual ICI increase the risk of irAEs with uncertain benefit for local recurrent disease.

Probably not. I would either send the recurrence for surgical resection and then switch to adjuvant ipilimumab, or offer a clinical trial.