➤ Recommendation 3.4. After progression on 1st line anti-PD1 therapy
patients with BRAF mutant (V600) unresectable/metastatic cutaneous
melanoma may be offered combination BRAF/MEK inhibitor therapy
as described in Recommendation 3.2. Similarly, those who have
progressed after combination BRAF/MEK inhibitor therapy may be
offered anti-PD1 therapy. In either case, ipilimumab or ipilimumab-
containing regimens may be offered instead. (Weak recommendation;
IC-L)
➤ Recommendation 3.5. For patients with injectable (cutaneous/
subcutaneous/nodal) unresectable lesions who are not eligible or do
not desire the recommended systemic therapies, T-VEC may be offered
as primary therapy. (Weak recommendation; EB-B-M)
Non-Cutaneous Melanoma (Stage II or greater)
➤ Recommendation 4.1. No recommendation for or against any specific
systemic therapy for patients with uveal melanoma may be made at
this time. Patients should be offered or referred for enrollment in
clinical trials where possible. (L)
➤ Recommendation 4.2. In the absence of additional data, the
consensus of the Expert Panel is that patients with unresectable/
metastatic mucosal melanoma may be offered therapy as described
in Recommendations 3.1 through 3.5. Patients should be offered
or referred for enrollment in clinical trials where possible. (Weak
recommendation; IC-L)
➤ Recommendation 4.3. No recommendation for or against any specific
systemic therapy for patients with any other form of non-cutaneous
melanoma may be made at this time. Patients should be offered or
referred for enrollment in clinical trials where possible.
