This protocol applies to patients with unresectable and/or metastatic mucosal melanoma — a distinct subtype arising from mucosal surfaces. Due to limited subtype-specific trial data, management is guided by expert consensus drawing on evidence from the broader unresectable and metastatic melanoma population.
Systemic immunotherapy-based combinations are a primary consideration in this setting, mirroring the approach used for unresectable or metastatic cutaneous melanoma. Targeted therapy is an additional option in tumours harbouring specific molecular alterations.
In the absence of further data, the consensus of the Expert Panel is that patients with unresectable and/or metastatic mucosal melanoma may be offered therapy as described in recommendations 3.1 through 3.5.
Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg iv once every 3 weeks for 4 doses, followed by nivolumab 3 mg/kg iv once every 2 weeks (CheckMate 067)
Relatlimab 160 mg and nivolumab 480 mg iv once every 4 weeks until progression (RELATIVITY-047)
Nivolumab 3 mg/kg iv once every 2 weeks (CheckMate 067)
Pembrolizumab 200 mg iv once every 3 weeks (US FDA‑approved)
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