Surgery in patients with metastatic melanoma treated with immune checkpoint inhibitors

Surgery has historically played a pivotal role in the management of metastatic melanoma, evolving significantly with the advances of systemic therapies. The advent of immune checkpoint inhibitors initially diminished the role of surgery in treatment paradigms; however, there has been a resurgence of interest in its application within this setting. Several retrospective studies show a survival benefit for patients treated with immune checkpoint inhibitors who are resected to no evidence of disease, especially in case of an objective response to modern therapies. This narrative review explores the role of surgery as a treatment modality in metastatic melanoma before and in the era of immune checkpoint inhibitors, highlighting indications, outcomes, and integration with systemic treatment approaches.