The therapy of choice for early stage melanoma is surgical excision, which is initially curative for the great majority of patients. However, only 40–60% of high-risk individuals who have surgery alone would be disease-free after 5 years. These patients will eventually develop loco-regional or distant recurrence. The primary goal of adjuvant treatments is to minimise the recurrence rate of radically operated patients who are at high risk of recurrence and, possibly, to enhance survival.Recently published practice-changing outcomes with immune checkpoint inhibitors and targeted treatments in stage III/IV melanoma patients following surgical full resection have drastically altered the landscape of adjuvant therapy. Interferon-, ipilimumab, and, more recently, anti-programmed cell death protein-1 antibodies and BRAF inhibitors plus MEK inhibitors have been approved in the adjuvant setting by the US Food and Drug Administration; similarly, with the exception of ipilimumab, the same drugs have been approved by the European Medicines Agency. In the neoadjuvant setting, a whole new situation is forming as well: Patients with locally advanced or metastatic illness may respond partially to neoadjuvant treatment and become practically resectable with systemic disease management.
This study highlights the present status of the field and explains novel methods, while also chronicling the history of adjuvant therapy in melanoma and looking ahead to future initiatives.