NEOADJUVANT THERAPY AND SURGICAL MANAGEMENT OF CUTANEOUS MELANOMA: A NARRATIVE REVIEW OF CURRENT EVIDENCE

• DOI: https://doi.org/10.22533/at.ed.01596826170611

• Palavras-chave: cutaneous melanoma; oncologic surgery; immunotherapy; sentinel lymph node; neoadjuvant treatment.

• Keywords: cutaneous melanoma; oncologic surgery; immunotherapy; sentinel lymph node; neoadjuvant treatment.

• Abstract:

  Cutaneous melanoma is the most aggressive malignant neoplasm among skin tumors due to its high metastatic potential and the significant mortality associated with advanced stages of the disease. Although it accounts for approximately 5% of skin cancers, it is responsible for the majority of deaths related to these neoplasms. In recent decades, advances in the understanding of tumor biology, the immune response, and the molecular mechanisms involved in melanoma progression have significantly altered the surgical treatment of this neoplasm. Surgery remains the primary treatment modality for localized disease; however, traditional concepts regarding surgical margins, lymph node management, and the optimal timing of intervention have undergone significant changes following the incorporation of immunotherapy and personalized medicine. This narrative review aims to compile and critically discuss the scientific evidence published between 2020 and 2026 regarding the contemporary surgical approach to cutaneous melanoma, emphasizing for surgery, advances in sentinel lymph node biopsy, changes related to lymphadenectomy, the integration of surgery with neoadjuvant immunotherapy, and future prospects for precision oncological surgery. We conclude that the current treatment of melanoma requires a multidisciplinary approach and individualized therapy based on clinical, histopathological, and molecular characteristics, leading to better oncological outcomes with lower morbidity.