Citation
Sun KH, Thakker S, Greenzaid J, Belzberg M, Miller DM, Patel VA. Perioperative treatment strategies for advanced melanoma and non-melanoma skin cancers. J Am Acad Dermatol. Published online October 6, 2025. doi:10.1016/j.jaad.2025.09.098.
Overview
Perioperative therapies—including neoadjuvant treatment and neoadjuvant therapy followed by adjuvant treatment—are emerging as promising approaches to improve the management of advanced cutaneous malignancies. This review summarizes key clinical trials and real-world studies across melanoma, cutaneous squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma.
Across disease settings, perioperative strategies—particularly those incorporating immune checkpoint inhibitors—have produced high pathologic response rates, improved survival outcomes, reduced treatment-related toxicity, and decreased surgical morbidity.
Perioperative treatment may create opportunities for response-directed care, treatment de-escalation, less morbid surgery, and, in carefully selected patients, avoidance of surgery altogether.
Topics highlighted
- Neoadjuvant and perioperative immune checkpoint inhibition
- Pathologic response as an early marker of treatment benefit
- Response-directed surgery and postoperative management
- Reduction of surgical morbidity and treatment intensity
- Evidence across melanoma, CSCC, BCC, and Merkel cell carcinoma
- Emerging opportunities for treatment de-escalation and surgical avoidance
Authors
Kennedy H. Sun, Sach Thakker, Jonathan Greenzaid, Micah Belzberg, David M. Miller, and Vishal A. Patel.