Neoadjuvant Systemic Therapy (NAST) in Patients with Melanoma: Surgical Considerations by the International Neoadjuvant Melanoma Consortium (INMC)

Alexander C.J. van Akkooi*, Tina J. Hieken, International Neoadjuvant Melanoma Consortium (INMC), Elizabeth M. Burton, Charlotte Ariyan, Paolo A. Ascierto, Salvatore V.M.A. Asero, Christian U. Blank, Matthew S. Block, Genevieve M. Boland, Corrado Caraco, Sydney Chng, B. Scott Davidson, Joao Pedreira Duprat Neto, Mark B. Faries, Jeffrey E. Gershenwald, Dirk J. Grunhagen, David E. Gyorki, Dale Han, Andrew J. HayesWinan J. van Houdt, Giorgos C. Karakousis, Willem M.C. Klop, Georgina V. Long, Michael C. Lowe, Alexander M. Menzies, Roger Olofsson Bagge, Thomas E. Pennington, Piotr Rutkowski, Robyn P.M. Saw, Richard A. Scolyer, Kerwin F. Shannon, Vernon K. Sondak, Hussein Tawbi, Alessandro A.E. Testori, Mike T. Tetzlaff, John F. Thompson, Jonathan S. Zager, Charlotte L. Zuur, Jennifer A. Wargo, Andrew J. Spillane, Merrick I. Ross

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

25 Citations (Scopus)
58 Downloads (Pure)


Exciting advances in melanoma systemic therapies have presented the opportunity for surgical oncologists and their multidisciplinary colleagues to test the neoadjuvant systemic treatment approach in high-risk, resectable metastatic melanomas. Here we describe the state of the science of neoadjuvant systemic therapy (NAST) for melanoma, focusing on the surgical aspects and the key role of the surgical oncologist in this treatment paradigm. This paper summarizes the past decade of developments in melanoma treatment and the current evidence for NAST in stage III melanoma specifically. Issues of surgical relevance are discussed, including the risk of progression on NAST prior to surgery. Technical aspects, such as the definition of resectability for melanoma and the extent and scope of routine surgery are presented. Other important issues, such as the utility of radiographic response evaluation and method of pathologic response evaluation, are addressed. Surgical complications and perioperative management of NAST related adverse events are considered. The International Neoadjuvant Melanoma Consortium has the goal of harmonizing NAST trials in melanoma to facilitate rapid advances with new approaches, and facilitating the comparison of results across trials evaluating different treatment regimens. Our ultimate goals are to provide definitive proof of the safety and efficacy of NAST in melanoma, sufficient for NAST to become an acceptable standard of care, and to leverage this platform to allow more personalized, biomarker-driven, tailored approaches to subsequent treatment and surveillance.

Original languageEnglish
Pages (from-to)3694-3708
Number of pages15
JournalAnnals of Surgical Oncology
Issue number6
Early online date28 Jan 2022
Publication statusPublished - Jun 2022

Bibliographical note

RAS and JFT are recipients of an Australian National
Health and Medical Research Council (NHMRC) Program Grant
(APP1093017), and RAS is supported by an NHMRC Practitioner
Fellowship (APP1141295). RPMS is supported by the Melanoma
Institute Australia. GVL is supported by an NHMRC Practitioner
Fellowship and The University of Sydney Medical Foundation.
Publisher Copyright:
© 2022, Society of Surgical Oncology.


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