Figure 1: Stage II melanoma immunotherapy treatment algorithm.
All treatment options shown may be appropriate, and final selection of therapy should be individualized based on patient eligibility and treatment availability at the physician's discretion. These algorithms represent consensus sequencing suggestions by the panel. (1) High-risk disease is defined as tumours >4 mm in diameter, ulcerated, and/or mitotic rate ≥1 per mm2. There is limited consensus on adjuvant therapy for this group with 43% of the panel recommending interferon-α2b, 38% recommending observation, 14% recommending clinical trial participation and no panellists recommending pegylated-interferon-α2. A minority (5%) recommended individualizing treatment for each patient. (2) There is no evidence that immunotherapy is useful in patients with low-risk stage II melanoma. (3) Patients should have a good performance status without evidence of significant depression, psychiatric history or underlying autoimmune disease to be considered for interferon-α2b. There are limited data available on interferon-α2b as treatment for stage II disease. (4) Clinical trials might be the preferred treatment recommendation for patients with stage II disease if they are available. Protocol-specific eligibility would need to be followed to appropriately select patients.
