Precision Oncology in Melanoma and Skin Cancer Surgery

Precision therapy based on the patient -specific genomic alterations of solid tumors has produced meaningful improvements in the treatment of advanced cancer over the past decade. This is especially true for patients with stage III and stage IV melanoma. Many of these successful treatments leverage the innate immunogenicity or the shared driver mutations of cutaneous melanoma. Effective precision therapy can be used in the perioperative period for patients with locally advanced disease and result in the conversion to resectable disease, thereby rendering a patient tumor -free. The toxicity of these treatments is not insignificant and can present in unique fashion relative to conventional cytotoxic chemotherapy regimens, requiring hyperacuity in the perioperative period. The role of the surgeon in the management of advanced melanoma has changed dramatically in the context of these new treatments where the timing, extent, and even candidacy for surgical resection are now more fluid than ever. Close collaboration among a multidisciplinary team as genomic-based treatment choices are made is absolutely essential to the safe and effective treatment of these patients.