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Adjuvant immunotherapy for melanoma

Author
Jeffrey A Sosman, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Surgical excision is the treatment of choice for early cutaneous melanoma and is curative in most cases. However, some patients will subsequently relapse with disseminated disease. High-risk features in the primary tumor and regional lymph node metastasis define patient subsets that are at increased risk for recurrent disease.

The use of adjuvant immunotherapy for high-risk melanoma will be reviewed here. The initial management of cutaneous melanoma and the management of patients with metastatic disease are discussed separately. (See "Initial surgical management of melanoma of the skin and unusual sites" and "Overview of the management of advanced cutaneous melanoma".)

GENERAL APPROACH TO ADJUVANT THERAPY

Staging and prognosis — For patients who have undergone a complete resection of a cutaneous melanoma, the decision of whether or not to recommend adjuvant therapy depends upon the risk of disease recurrence, based upon the stage at diagnosis, along with a consideration of patient age, comorbidity, and personal preferences.

The extent and characteristics of the primary tumor and regional lymph node involvement allow classification of patients into different risk categories. The tumor, nodes, metastasis (TNM) staging system of the American Joint Committee on Cancer (AJCC) (table 1A-B) incorporates the most important determinants of prognosis [1,2]. (See "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma".)

For the primary tumor (T), increasing tumor thickness, an increased mitotic rate, and the presence of ulceration (ie, the loss of the epidermal layer overlying the primary tumor) are associated with an increased risk of relapse (figure 1).

                 

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT+00:00 2016.
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