{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:06:45Z","timestamp":1779368805126,"version":"3.53.0"},"reference-count":59,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Melanoma adjuvant therapy has substantially improved recurrence-free and distant metastasis-free survival in patients with resected high-risk disease, and more recently, these advances have extended to earlier stages. However, important unmet needs remain, including the management of stage IIIA disease, the optimal treatment strategy after relapse on adjuvant therapy, and the identification of biomarkers capable of refining patient selection. This review summarizes recent advances and unresolved questions in the adjuvant and neoadjuvant treatment of melanoma. We discuss novel systemic strategies, including immune checkpoint inhibitor combinations and personalized neoantigen mRNA vaccines, together with the expanding role of neoadjuvant approaches. We also examine prognostic and predictive tools\u2014such as clinicopathologic models, circulating tumor DNA, serum biomarkers, tumor microenvironment features, and gene expression profiling\u2014that may help better define recurrence risk and therapeutic benefit. Current evidence suggests that although modern therapies have changed the natural history of resected melanoma, a substantial proportion of patients are still overtreated or undertreated when treatment decisions are based on stage alone. Future progress will depend on integrating biological risk stratification with clinical staging and optimizing treatment sequencing across adjuvant and neoadjuvant settings.<\/jats:p>","DOI":"10.3390\/cancers18101669","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:06:07Z","timestamp":1779365167000},"page":"1669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["New Perspectives and Open Issues in the Adjuvant and Neoadjuvant Treatment of Melanoma"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-1849","authenticated-orcid":false,"given":"Andrea","family":"Spagnoletti","sequence":"first","affiliation":[{"name":"Unit of Melanoma Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7297-319X","authenticated-orcid":false,"given":"Lorenza","family":"Di Guardo","sequence":"additional","affiliation":[{"name":"Unit of Melanoma Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Indini","sequence":"additional","affiliation":[{"name":"Unit of Melanoma Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"},{"name":"Immunotherapy and Innovative Therapeutics Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7689-5774","authenticated-orcid":false,"given":"Massimo","family":"Di Nicola","sequence":"additional","affiliation":[{"name":"Immunotherapy and Innovative Therapeutics Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Patuzzo","sequence":"additional","affiliation":[{"name":"Department of Melanoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Maurichi","sequence":"additional","affiliation":[{"name":"Department of Melanoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8443-7458","authenticated-orcid":false,"given":"Paolo","family":"Fava","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Dermatology, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-5506","authenticated-orcid":false,"given":"Gabriele","family":"Roccuzzo","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Dermatology, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7712-7286","authenticated-orcid":false,"given":"Alessandro","family":"Minisini","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Santa Maria della Misericordia Academic Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pravisano","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Santa Maria della Misericordia Academic Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2427-8915","authenticated-orcid":false,"given":"Jacopo","family":"Pigozzo","sequence":"additional","affiliation":[{"name":"Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Piccin","sequence":"additional","affiliation":[{"name":"Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Cimminiello","sequence":"additional","affiliation":[{"name":"Melanoma Unit, Division of Clinical and Experimental Oncology and Immunotherapy of Melanoma, European Institute of Oncology, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Melanoma Unit, Division of Clinical and Experimental Oncology and Immunotherapy of Melanoma, European Institute of Oncology, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9060-2512","authenticated-orcid":false,"given":"Michele","family":"Del Vecchio","sequence":"additional","affiliation":[{"name":"Unit of Melanoma Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9522","DOI":"10.1200\/JCO.2022.40.16_suppl.9522","article-title":"Long-Term Survival in Advanced Melanoma for Patients Treated with Nivolumab plus Ipilimumab in CheckMate 067","volume":"40","author":"Hodi","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1200\/JCO.22.00533","article-title":"Adjuvant Therapy of Nivolumab Combined With Ipilimumab Versus Nivolumab Alone in Patients With Resected Stage IIIB-D or Stage IV Melanoma (CheckMate 915)","volume":"41","author":"Weber","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/S0140-6736(22)01654-3","article-title":"Adjuvant Nivolumab plus Ipilimumab or Nivolumab Alone versus Placebo in Patients with Resected Stage IV Melanoma with No Evidence of Disease (IMMUNED): Final Results of a Randomised, Double-Blind, Phase 2 Trial","volume":"400","author":"Livingstone","year":"2022","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4301","DOI":"10.1038\/s41591-025-04032-8","article-title":"Adjuvant Nivolumab and Relatlimab in Stage III\/IV Melanoma: The Randomized Phase 3 RELATIVITY-098 Trial","volume":"31","author":"Long","year":"2025","journal-title":"Nat. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1470-2045(25)00709-0","article-title":"Vibostolimab Coformulated with Pembrolizumab versus Pembrolizumab Alone as Adjuvant Therapy for High-Risk Stage IIB\u2013IV Melanoma (KEYVIBE-010): A Randomised, Double-Blind, Phase 3 Study","volume":"27","author":"Dummer","year":"2026","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12943-019-1055-6","article-title":"Neoantigen Vaccine: An Emerging Tumor Immunotherapy","volume":"18","author":"Peng","year":"2019","journal-title":"Mol. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1200\/JCO.2012.43.7111","article-title":"Selection of Immunostimulant AS15 for Active Immunization with MAGE-A3 Protein: Results of a Randomized Phase II Study of the European Organisation for Research and Treatment of Cancer Melanoma Group in Metastatic Melanoma","volume":"31","author":"Kruit","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/S1470-2045(18)30254-7","article-title":"MAGE-A3 Immunotherapeutic as Adjuvant Therapy for Patients with Resected, MAGE-A3-Positive, Stage III Melanoma (DERMA): A Double-Blind, Randomised, Placebo-Controlled, Phase 3 Trial","volume":"19","author":"Dreno","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1056\/NEJMoa1012863","article-title":"Gp100 Peptide Vaccine and Interleukin-2 in Patients with Advanced Melanoma","volume":"364","author":"Schwartzentruber","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1038\/s41591-020-01206-4","article-title":"Personal Neoantigen Vaccines Induce Persistent Memory T Cell Responses and Epitope Spreading in Patients with Melanoma","volume":"27","author":"Hu","year":"2021","journal-title":"Nat. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/nature23003","article-title":"Personalized RNA Mutanome Vaccines Mobilize Poly-Specific Therapeutic Immunity against Cancer","volume":"547","author":"Sahin","year":"2017","journal-title":"Nature"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"LBA9512","DOI":"10.1200\/JCO.2024.42.17_suppl.LBA9512","article-title":"Individualized Neoantigen Therapy MRNA-4157 (V940) plus Pembrolizumab in Resected Melanoma: 3-Year Update from the MRNA-4157-P201 (KEYNOTE-942) Trial","volume":"42","author":"Weber","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102127","DOI":"10.1016\/j.suronc.2024.102127","article-title":"Neoadjuvant Therapy for Melanoma: Past, Present, and Future","volume":"56","author":"Therien","year":"2024","journal-title":"Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"eaax0182","DOI":"10.1126\/science.aax0182","article-title":"Neoadjuvant Checkpoint Blockade for Cancer Immunotherapy","volume":"367","author":"Topalian","year":"2020","journal-title":"Science"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1056\/NEJMoa2402604","article-title":"Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma","volume":"391","author":"Blank","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1038\/s41591-025-04158-9","article-title":"Neoadjuvant Ipilimumab plus Nivolumab in Melanoma: 5-Year Survival and Biomarker Analysis from the Phase 2 PRADO-Trial","volume":"32","author":"Hoeijmakers","year":"2026","journal-title":"Nat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/S1470-2045(19)30151-2","article-title":"Identification of the Optimal Combination Dosing Schedule of Neoadjuvant Ipilimumab plus Nivolumab in Macroscopic Stage III Melanoma (OpACIN-Neo): A Multicentre, Phase 2, Randomised, Controlled Trial","volume":"20","author":"Rozeman","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1038\/s41591-022-01851-x","article-title":"Personalized Response-Directed Surgery and Adjuvant Therapy after Neoadjuvant Ipilimumab and Nivolumab in High-Risk Stage III Melanoma: The PRADO Trial","volume":"28","author":"Reijers","year":"2022","journal-title":"Nat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S1600","DOI":"10.1016\/j.annonc.2025.09.069","article-title":"LBA57 Two-Year Clinical Update and First Biomarker Analyses of the Phase III NADINA Trial Comparing Neoadjuvant Nivolumab plus Ipilimumab versus Adjuvant Nivolumab in Resectable Stage III Melanoma","volume":"36","author":"Lucas","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"114120","DOI":"10.1016\/j.ejca.2024.114120","article-title":"Open-Label, Phase II Study of Talimogene Laherparepvec plus Pembrolizumab for the Treatment of Advanced Melanoma That Progressed on Prior Anti\u2013PD-1 Therapy: MASTERKEY-115","volume":"207","author":"Robert","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.annonc.2025.06.014","article-title":"Neoadjuvant Intralesional Targeted Immunocytokines (Daromun) in Stage III Melanoma","volume":"36","author":"Hassel","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_22","first-page":"472","article-title":"Melanoma Staging: Evidence-Based Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA A Cancer J. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3345","DOI":"10.1200\/JCO.2004.12.177","article-title":"The Microanatomic Location of Metastatic Melanoma in Sentinel Lymph Nodes Predicts Nonsentinel Lymph Node Involvement","volume":"22","author":"Dewar","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1038\/s41379-021-00835-5","article-title":"The Sentinel Node Invasion Level (SNIL) as a Prognostic Parameter in Melanoma","volume":"34","author":"Kretschmer","year":"2021","journal-title":"Mod. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ejca.2019.07.004","article-title":"Melanoma-Specific Survival in Patients with Positive Sentinel Lymph Nodes: Relevance of Sentinel Tumor Burden","volume":"123","author":"Satzger","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113912","DOI":"10.1016\/j.ejca.2024.113912","article-title":"Isolated Melanoma Cells in Sentinel Lymph Node in Stage IIIA Melanoma Correlate with a Favorable Prognosis Similar to Stage IB","volume":"201","author":"Amaral","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3940","DOI":"10.1200\/JCO.21.02488","article-title":"Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases from an International Multicenter Study: Implications for the Management of American Joint Committee on Cancer IIIA Disease","volume":"40","author":"Moncrieff","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9518","DOI":"10.1200\/JCO.2023.41.16_suppl.9518","article-title":"Efficacy of Adjuvant Therapy in Patients (Pts) with AJCC v8 Stage IIIA Cutaneous Melanoma","volume":"41","author":"Grover","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S1470-2045(24)00076-7","article-title":"Development and Validation of a Novel Model to Predict Recurrence-Free Survival and Melanoma-Specific Survival after Sentinel Lymph Node Biopsy in Patients with Melanoma: An International, Retrospective, Multicentre Analysis","volume":"25","author":"Stassen","year":"2024","journal-title":"Lancet Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/jnci\/djx133","article-title":"Relapse-Free Survival as a Surrogate for Overall Survival in the Evaluation of Stage II-III Melanoma Adjuvant Therapy","volume":"110","author":"Suciu","year":"2018","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1056\/NEJMoa1611299","article-title":"Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy","volume":"375","author":"Eggermont","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1016\/S1470-2045(20)30494-0","article-title":"Adjuvant Nivolumab versus Ipilimumab in Resected Stage IIIB-C and Stage IV Melanoma (CheckMate 238): 4-Year Results from a Multicentre, Double-Blind, Randomised, Controlled, Phase 3 Trial","volume":"21","author":"Ascierto","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"LBA9505","DOI":"10.1200\/JCO.2023.41.17_suppl.LBA9505","article-title":"Pembrolizumab versus Placebo as Adjuvant Therapy in Stage IIB or IIC Melanoma: Final Analysis of Distant Metastasis-Free Survival in the Phase 3 KEYNOTE-716 Study","volume":"41","author":"Luke","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100021","DOI":"10.1016\/j.ejcskn.2024.100021","article-title":"Adjuvant Systemic Therapy in Melanoma: Relative versus Absolute Benefit; the Number Needed to Treat (NNT) versus the Number Needed to Harm (NNH)?","volume":"2","author":"Mandala","year":"2024","journal-title":"EJC Ski. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"EVIDoa2200214","DOI":"10.1056\/EVIDoa2200214","article-title":"Five-Year Analysis of Adjuvant Pembrolizumab or Placebo in Stage III Melanoma","volume":"1","author":"Eggermont","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.annonc.2020.04.471","article-title":"Management of Early Melanoma Recurrence despite Adjuvant Anti-PD-1 Antibody Therapy","volume":"31","author":"Owen","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1038\/s41591-023-02498-y","article-title":"Ipilimumab with or without Nivolumab in PD1\/PDL1 Blockade Refractory Metastatic Melanoma: A Randomized Phase 2 Trial","volume":"29","author":"VanderWalde","year":"2023","journal-title":"Nat. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e7257","DOI":"10.1002\/cam4.7257","article-title":"Real-World Outcomes of Patients with Resected Stage III Melanoma Treated with Adjuvant Therapies","volume":"13","author":"Dima","year":"2024","journal-title":"Cancer Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e000398","DOI":"10.1136\/jitc-2019-000398","article-title":"Defining Tumor Resistance to PD-1 Pathway Blockade: Recommendations from the First Meeting of the SITC Immunotherapy Resistance Taskforce","volume":"8","author":"Kluger","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"113561","DOI":"10.1016\/j.ejca.2024.113561","article-title":"Efficacy and Safety of \u201cSecond Adjuvant\u201d Therapy with BRAF\/MEK Inhibitors after Local Therapy for Recurrent Melanoma Following Adjuvant PD-1 Based Immunotherapy","volume":"199","author":"Taylor","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1177\/0300891619868009","article-title":"Developing a Score System to Predict Therapeutic Outcomes to Anti-PD-1 Immunotherapy in Metastatic Melanoma","volume":"105","author":"Indini","year":"2019","journal-title":"Tumori. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1093\/annonc\/mdz048","article-title":"Prediction and Monitoring of Relapse in Stage III Melanoma Using Circulating Tumor DNA","volume":"30","author":"Tan","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.celrep.2015.08.077","article-title":"Tumor-Expressed IDO Recruits and Activates MDSCs in a Treg-Dependent Manner","volume":"13","author":"Holmgaard","year":"2015","journal-title":"Cell Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/CMR.0b013e32833ba9ff","article-title":"Prognostic Factors Associated with Sentinel Lymph Node Positivity and Effect of Sentinel Status on Survival: An Analysis of 1049 Patients with Cutaneous Melanoma","volume":"20","author":"Kunte","year":"2010","journal-title":"Melanoma Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1158\/2159-8290.CD-15-1545","article-title":"Analysis of Immune Signatures in Longitudinal Tumor Samples Yields Insight into Biomarkers of Response and Mechanisms of Resistance to Immune Checkpoint Blockade","volume":"6","author":"Chen","year":"2016","journal-title":"Cancer Discov."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1056\/NEJMoa1406498","article-title":"Genetic Basis for Clinical Response to CTLA-4 Blockade in Melanoma","volume":"371","author":"Snyder","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.cell.2016.02.065","article-title":"Genomic and Transcriptomic Features of Response to Anti-PD-1 Therapy in Metastatic Melanoma","volume":"165","author":"Hugo","year":"2016","journal-title":"Cell"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"9504","DOI":"10.1200\/JCO.2023.41.16_suppl.9504","article-title":"Association of Biomarkers (BMs) with Efficacy of Adjuvant Nivolumab (NIVO) vs Placebo (PBO) in Patients with Resected Stage IIB\/C Melanoma (CA209-76K)","volume":"41","author":"Long","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S1470-2045(20)30062-0","article-title":"Adjuvant Dabrafenib plus Trametinib versus Placebo in Patients with Resected, BRAFV600-Mutant, Stage III Melanoma (COMBI-AD): Exploratory Biomarker Analyses from a Randomised, Phase 3 Trial","volume":"21","author":"Dummer","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"E7769","DOI":"10.1073\/pnas.1607836113","article-title":"Association of PD-1\/PD-L Axis Expression with Cytolytic Activity, Mutational Load, and Prognosis in Melanoma and Other Solid Tumors","volume":"113","author":"Danilova","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1038\/s41591-020-01211-7","article-title":"Survival and Biomarker Analyses from the OpACIN-Neo and OpACIN Neoadjuvant Immunotherapy Trials in Stage III Melanoma","volume":"27","author":"Rozeman","year":"2021","journal-title":"Nat. Med."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Wheeler, C.E., Samuel, S., Coleman, I., Hoyd, R., Denko, L., Chan, C.H.F., Churchman, M.L., Denko, N., Dodd, R.D., and Eljilany, I. (2023). The Tumor Microbiome as a Predictor of Outcomes in Patients with Metastatic Melanoma Treated with Immune Checkpoint Inhibitors. bioRxiv.","DOI":"10.1101\/2023.05.24.542123"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s12672-023-00622-5","article-title":"Machine Learning to Predict Overall Short-Term Mortality in Cutaneous Melanoma","volume":"14","author":"Cozzolino","year":"2023","journal-title":"Discov. Oncol."},{"key":"ref_54","first-page":"2249","article-title":"Dermatologic Disease-Directed Targeted Therapy (D3T2): The Application of Biomarker-Based Precision Medicine for the Personalized Treatment of Skin Conditions-Precision Dermatology","volume":"12","author":"Cohen","year":"2022","journal-title":"Dermatol. Ther."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/978-1-62703-727-3_22","article-title":"A Prognostic Test to Predict the Risk of Metastasis in Uveal Melanoma Based on a 15-Gene Expression Profile","volume":"1102","author":"Harbour","year":"2014","journal-title":"Methods Mol. Biol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1158\/1078-0432.CCR-13-3316","article-title":"Development of a Prognostic Genetic Signature to Predict the Metastatic Risk Associated with Cutaneous Melanoma","volume":"21","author":"Gerami","year":"2015","journal-title":"Clin. Cancer Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.jaad.2020.03.053","article-title":"Molecular Risk Prediction in Cutaneous Melanoma: A Meta-Analysis of the 31-Gene Expression Profile Prognostic Test in 1,479 Patients","volume":"83","author":"Greenhaw","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"pky032","DOI":"10.1093\/jncics\/pky032","article-title":"A Prognostic Gene Signature Expressed in Primary Cutaneous Melanoma: Synergism With Conventional Staging","volume":"2","author":"Brunner","year":"2018","journal-title":"JNCI Cancer Spectr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"115372","DOI":"10.1016\/j.ejca.2025.115372","article-title":"Risk stratification using the Merlin Assay (CP-GEP) in an independent cohort of 930 patients with clinical stage I\/II melanoma who did not undergo sentinel lymph node biopsy","volume":"220","author":"Amaral","year":"2025","journal-title":"Eur. J. Cancers"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:27:59Z","timestamp":1779366479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":59,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101669"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101669","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}