Neoadjuvant ICIs for stage III melanoma: representativeness of response of index lymph node for response of total nodal basin

Neoadjuvant checkpoint inhibition in patients with high-risk stage III melanoma results in high pathologic response rates associated with durable relapse-free survival. It is not known whether therapeutic lymph node dissection (TLND) can be safely omitted when a major pathologic response is obtained in the largest lymph node metastasis at baseline (index lymph node, ILN). Retrospective analysis of two prospective studies found that pathologic response of the ILN may be considered a reliable indicator of the entire TLND specimen response and may support the ILN response-directed omission of TLND in a prospective trial.