Where do we stand on adjuvant melanoma therapy?

Melanoma remains the deadliest form of skin cancer, and its incidence is increasing. In recent years, melanoma adjuvant therapy has been regarded as a revolution when it comes to prognostic of high-risk melanoma adjuvant therapy has been regarded as a revolution in the prognostic of high-risk melanoma, but questions concerning its indications still challenge the clinical approach. A better understanding of what patients to treat and how to treat them is imperative. Adjuvant therapy is now considered standard of care in many clinical contexts, and currently approved therapies have shown benefit in patients staged III or higher on the American Joint Committee on Cancer (AJCC) 7th edition, which raised issues of adequacy in present clinical settings (AJCC 8th edition). Nevertheless, clinical practice guidelines are unavailable. Furthermore, clinical settings have evolved since the trials that led to the approval of current adjuvant treatments. Completion lymph node dissection is no longer considered standard of care for all sentinel lymph node (SLN)—positive patients, and staging was reconfigured. In light of AJCC’s new staging data, early adjuvant therapy –for stage II melanoma– is now under scrutiny. Several breakthroughs are expected in the upcoming years. This review summarizes where we came from, where we are and where we are heading on adjuvant melanoma therapy.