Systemic Therapy for Melanoma: ASCO Guideline

J Clin Oncol. 2020 Nov 20;38(33):3947-3970. doi: 10.1200/JCO.20.00198. Epub 2020 Mar 31.


Purpose: To provide guidance to clinicians regarding the use of systemic therapy for melanoma.

Methods: ASCO convened an Expert Panel and conducted a systematic review of the literature.

Results: A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma.

Recommendations: In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at

Publication types

  • Practice Guideline
  • Systematic Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Humans
  • Imidazoles / administration & dosage
  • Imidazoles / therapeutic use
  • Melanoma / drug therapy*
  • Meta-Analysis as Topic
  • Oximes / administration & dosage
  • Oximes / therapeutic use
  • Pyridones / administration & dosage
  • Pyridones / therapeutic use
  • Pyrimidinones / administration & dosage
  • Pyrimidinones / therapeutic use
  • Randomized Controlled Trials as Topic
  • Skin Neoplasms / drug therapy*
  • Systematic Reviews as Topic
  • Uveal Neoplasms / drug therapy


  • Imidazoles
  • Oximes
  • Pyridones
  • Pyrimidinones
  • trametinib
  • dabrafenib

Supplementary concepts

  • Uveal melanoma