A new era of risk prediction for patients with high-risk melanoma

In The Lancet Oncology, Robert C Stassen and colleagues1 report the development of a new model to predict recurrence-free survival and melanoma-specific survival in people with stage II or III melanoma. Since the introduction in 2018 of adjuvant systemic therapies for use after surgical resection of high-risk melanoma, there has been growing awareness of the need for individualised assessment of the risk of recurrence to guide treatment decisions. According to the 8th edition of the American Joint Committee on Cancer's (AJCC) Cancer Staging Manual, on which current treatment recommendations are based, the distinction between stage II and III disease is based on lymph node status and the presence of satellite or in-transit metastases, rather than the risk, per se, of melanoma recurrence or death. Patients with stage IIIA melanoma per the AJCC staging system actually have better prognoses than those with stage IIC disease, but adjuvant treatment was not recommended for the latter patient group until late 2021.2 The recurrence-free survival benefit associated with treatment is very similar across all stages, and adjuvant PD-1 inhibitors are now approved for use in patients with stage IIB–IIID disease.3 However, adjuvant immunotherapy is costly and is associated with the potential for enduring life-long adverse events.