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Despite established clinical guidelines, certain areas of its management in Spain remain heterogeneous, particularly in complex scenarios such as neoadjuvant therapy, metastatic sequencing, and follow-up. This project aimed to generate expert-informed recommendations to standardize care in areas of clinical uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A two-round Delphi process was conducted. Following a systematized review, a multidisciplinary panel of 35 specialists (oncology, dermatology, surgery, and pathology) evaluated 59 statements on uncertain areas of melanoma management. Consensus was defined as\u2009\u2265\u200980% agreement using a 5-point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 52 statements achieved consensus (3 unanimous, 49 by agreement). Key findings support the use of neoadjuvant immunotherapy in resectable stage III melanoma, particularly in patients with clinically detectable nodal disease, due to its benefit in reducing recurrence risk. A major pathological response was considered a key factor to individualize subsequent surgical and adjuvant decisions. In metastatic disease, therapeutic sequencing algorithms were defined according to BRAF mutational status, prior treatments, and timing of progression. The panel agreed that PD-L1 expression should not be used as the sole factor to exclude patients from anti-PD-1 therapy. Marked variability in follow-up practices was identified, highlighting the need for standardized approaches and quality indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This Delphi consensus reflects the views of a multidisciplinary panel of Spanish melanoma experts on key areas of uncertainty in melanoma management. By integrating evidence and expert experience, the findings may help support clinical decision-making and serve as a complementary reference for clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12094-026-04539-7","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:55:47Z","timestamp":1792173347000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring uncertainties in melanoma management: a Spanish multidisciplinary Delphi consensus"],"prefix":"10.1007","author":[{"given":"Aram","family":"Boada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Berrocal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel-\u00c1ngel","family":"Berciano-Guerrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Casado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Espinosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iv\u00e1n","family":"M\u00e1rquez-Rodas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Nagore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Pu\u00e9rtolas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Rodr\u00edguez-Peralto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Ostios-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"S\u00e1ez-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7556-7608","authenticated-orcid":false,"given":"Eva","family":"Mu\u00f1oz-Couselo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"4539_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1177\/002215540205000201","volume":"50","author":"M Tsatmali","year":"2002","unstructured":"Tsatmali M, Ancans J, Thody AJ. 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J Clin Epidemiol. 2014;67:401\u20139. https:\/\/doi.org\/10.1016\/j.jclinepi.2013.12.002.","journal-title":"J Clin Epidemiol"}],"container-title":["Clinical and Translational Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12094-026-04539-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12094-026-04539-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12094-026-04539-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:55:48Z","timestamp":1792173348000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12094-026-04539-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":42,"alternative-id":["4539"],"URL":"https:\/\/doi.org\/10.1007\/s12094-026-04539-7","relation":{},"ISSN":["1699-3055"],"issn-type":[{"value":"1699-3055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"11 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"ABG received grants or contracts from Bristol-Myers Squibb; honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from MSD and Almirall; support for attending meetings and\/or travel from Almirall, Galderma, Cantabria Labs, Leo Pharma, and Biofrontera. AB received consulting fees from MSD, Pierre Fabre, Regeneron; honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing, or educational events from MSD, Bristol-Myers Squibb, Pierre Fabre, Regeneron; support for attending meetings from Pierre Fabre and MSD. MABG received honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from MSD, Bristol-Myers Squibb, Novartis, Pierre Fabre, and Regeneron; payment for experts\u2019 testimony from Regeneron and Bristol-Myers Squibb; support for attending meetings and\/or travel from Novartis and Pierre Fabre. CC received honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from Grupo Espa\u00f1ol Melanoma (GEM); participation on Advisory Board from Laboratorios Urgo. EE received honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing, or educational events from Bristol-Myers Squibb, Immunocore, MSD, Novartis, and Pierre Fabre; support for attending meetings and\/or travel from Pierre Fabre; participation on Advisory Board from Immunocore. IMR received consulting fees from Amgen, Astra Zeneca, BioLineRx, Bristol-Myers Squibb, Celgene Corporation, GSK, Highlight Therapeutics, Immunocore Holdings, Merck Serono, MSD, Novartis, Pierre Fabre, Regeneron, Roche, Sanofi, and Sun Pharma; support for attending meetings and\/or travel from Amgen, Bristol Myers Squibb, GSK, Highlight Therapeutics, MSD, Novartis, Pierre Fabre, Roche, and Sun Pharma. EN received consulting fees form Almirall; honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from MSD; support for attending meetings and\/or travel from Sun Pharma, Cantabria Labs, ISDIN; participation on a Data Safety Monitoring Board or Advisory Board from Bristol-Myers Squibb; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid from Fundacion Piel Sana de la Academia Espa\u00f1ola de Dermatology y Venerology; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Bristol-Myers Squibb. TP received honoraria for lectures, presentations, speakers\u2019 bureaus, manuscript writing or educational events from Bristol-Myers Squibb, Novartis, Pierre Fabre, Sun Pharma; support for attending meetings and\/or travel from MSD, Pierre Fabre; participation on a Data Safety Monitoring Board or Advisory Board from Bristol-Myers Squibb, Seagen, Pierre Fabre, and Sun Pharma. JLRP has nothing to declare. LOG is a current employee of Bristol-Myers Squibb. CSL has nothing to declare. EMC received consulting fees from Bristol-Myers Squibb, MSD, Pierre Fabre, Regeneron, Sanofi, Novartis, and Menarini; honoraria for lectures, presentations, speakers\u2019 bureaus, manuscripts writing, or educational events from Bristol-Myers Squibb, MSD, Pierre Fabre, Novartis; support for attending meetings and\/or travel from MSD, Novartis, and Pierre Fabre. The current study was funded by Bristol Myers Squibb. The sponsor did not have any role in the prioritization of questions to address, the formulation of statements, or interpretation of results.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript reports the results of a Delphi consensus study aimed at addressing areas of uncertainty in melanoma management in Spain. The study was based on a systematized literature review and a two-round Delphi process involving a multidisciplinary panel of experts in melanoma care. This study cannot be considered human subjects research, as no patients, biological samples, or personal health data were involved. Consequently, ethics committee approval and written informed consent were not required.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}