Treatment of Resectable Stage III Melanoma with Pathologically Proven, Clinically or Radiologically Detectable Lymph Node Metastasis

This protocol covers patients with resectable stage III melanoma in whom lymph node involvement is both pathologically confirmed and clinically or radiologically detectable — a presentation that calls for a specific, evidence-based treatment sequence distinct from occult nodal disease.

Clinical scenario

Resectable stage III melanoma with pathologically proven, clinically or radiologically detectable lymph node metastasis. The overt nodal burden at this stage informs the choice and timing of both systemic and surgical intervention.

Treatment approach — partial overview

Current evidence supports delivering systemic immunotherapy before surgery (neoadjuvant), with the extent of subsequent adjuvant treatment determined by the degree of pathological response achieved at resection. Tumour molecular profile also influences adjuvant selection.

Full sequencing, all alternatives, and molecular-stratified adjuvant options are available in the complete protocol →

Instant Access to Structured Evidence-Based Regimens

References

For patients with resectable stage III melanoma and pathologically proven, clinically or radiologically detectable LN metastasis, neoadjuvant nivolumab+ipilimumab [ESMO-MCBS v1.1 score: A; not EMA or FDA approved] followed by surgery should be offered.

For patients with an MPR defined according to INMC criteria, adjuvant treatment can be omitted.

In the neoadjuvant group, only patients who had a pPR or pNR received subsequent adjuvant treatment with either dabrafenib+trametinib (for BRAF-mutated melanoma) or nivolumab.

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