How surgical strategies are modified by new adjuvant treatments: oncological dermatology (or Perioperative systemic treatments in oncological dermatology: impact on surgical and reconstructive strategies)
Seance of wednesday 20 may 2026 (L'Académie reçoit la Société Francophone de Chirurgie Oncologique)
DOI number : 10.26299/wm5s-js46/emem.2026.21.03
Abstract
Perioperative systemic treatments are profoundly reshaping surgical strategies in oncological dermatology, altering the timing, extent, and nature of resection and reconstruction.
In resectable stage III melanoma, the phase 3 NADINA trial demonstrated the superiority of neoadjuvant nivolumab-ipilimumab over upfront surgery followed by adjuvant therapy, with 12-month event-free survival of 83.7% versus 57.2%. Major pathological responses in 59% of patients enable surgical de-escalation at the nodal level, with immunotherapy progressively replacing lymph node dissection in selected cases and reducing surgical morbidity. The role of sentinel lymph node biopsy is also evolving: increasingly less decisive for dissection indications, it is becoming a tool for identifying predictive biomarkers of immunotherapy response. In practice, this neoadjuvant approach requires a preoperative delay to maximize tumor response and adapt the extent of both resection and reconstruction accordingly.
In locally advanced cutaneous squamous cell carcinoma, neoadjuvant cemiplimab induces complete pathological responses in 51 to 55% of cases, enabling less mutilating surgery, reducing the need for adjuvant radiotherapy, and sometimes fundamentally altering the reconstructive procedure required.
In both settings, pathological response is emerging as a central predictive indicator that structures the decision to operate, the choice of surgical gesture, and reconstructive planning.
In resectable stage III melanoma, the phase 3 NADINA trial demonstrated the superiority of neoadjuvant nivolumab-ipilimumab over upfront surgery followed by adjuvant therapy, with 12-month event-free survival of 83.7% versus 57.2%. Major pathological responses in 59% of patients enable surgical de-escalation at the nodal level, with immunotherapy progressively replacing lymph node dissection in selected cases and reducing surgical morbidity. The role of sentinel lymph node biopsy is also evolving: increasingly less decisive for dissection indications, it is becoming a tool for identifying predictive biomarkers of immunotherapy response. In practice, this neoadjuvant approach requires a preoperative delay to maximize tumor response and adapt the extent of both resection and reconstruction accordingly.
In locally advanced cutaneous squamous cell carcinoma, neoadjuvant cemiplimab induces complete pathological responses in 51 to 55% of cases, enabling less mutilating surgery, reducing the need for adjuvant radiotherapy, and sometimes fundamentally altering the reconstructive procedure required.
In both settings, pathological response is emerging as a central predictive indicator that structures the decision to operate, the choice of surgical gesture, and reconstructive planning.