Clinical Trials in Melanoma Margins, Lymph Nodes, Targeted and Immunotherapy

The current guidelines for the surgical care of cutaneous melanoma have been shaped by multiple randomized controlled clinical trials. Six prospective randomized trials performed between 1980 and 2004 have informed the current NCCN guidelines for margin excision in melanoma, and the currently enrolling MelMarT trial will provide important information on the safety of narrower surgical margins for thicker lesions in the era of SLNB. MSLT-I led to the common practice of SLNB for patients with intermediate thickness and thick melanomas primarily for prognostication and staging, and MSLT-II and DECOG-SLT demonstrated safety in observing the nodal basin with serial ultrasound compared with immediate CLND in patients with a positive sentinel node. Additionally, for patients with nodal disease (stage III), recent developments in targeted and immune therapy have led to effective adjuvant therapy options with demonstrated improvements in RFS. As the melanoma landscape continues to evolve with an increasing interest in neoadjuvant therapy approaches, it is anticipated that future clinical trials will continue to change practice, improving the care for patients with cutaneous melanoma.

Automated summary

The current guidelines for the surgical care of cutaneous melanoma have been shaped by multiple randomized controlled clinical trials. These trials have provided important guidance for margin excision and sentinel lymph node biopsy in melanoma patients, and the development of targeted therapy and immunotherapy has offered effective adjuvant treatment options.