Karla A. Lee, Paul Nathan
DOI: 10.2340/00015555-3496

This decade has brought significantly improved outcomes for patients with advanced melanoma with immunotherapies and targeted treatments offering utility in a variety of settings. In 2020, we can hope for durable long-term responses, and complete remission in a subset of patients with metastatic disease. In the adjuvant setting, approximately 50% improvements in recurrence-free survival are seen both with targeted and immunotherapies. Early data from neoadjuvant immunotherapy clinical trials are very promising. However, responses to treatment are heterogeneous and not always durable; further advances are required, and several emerging strategies are of particular interest. We review the systemic treatment of melanoma, discussing the treatment of unresectable stage III–IV and recurrent disease, outlining curative treatment of cutaneous melanoma in the adjuvant setting and briefly discussing neoadjuvant systemic therapies for advanced melanoma.

Melanoma is an aggressive and rare skin cancer that can threaten the lives of patients it affects. New treatments have been introduced over the past decade which have dramatically changed the way in which patients with advanced melanoma are managed. Here we review the treatments currently available to patients with advanced melanoma, focusing firstly on patients with stage 4 melanoma. We also review treatments available to reduce the risk of a melanoma returning – these treatments can be given either before (“neoadjuvantly”) or after (“adjuvantly”) a melanoma is surgically removed, but only the latter is currently approved.