Comparing two surgical approaches after immune therapy for melanoma

This trial is testing a new approach to surgery for melanoma that has spread to lymph nodes. After patients receive immune-boosting medications (such as nivolumab or pembrolizumab) for about 6 weeks, they will have surgery. The study compares two surgical approaches: removing only the largest affected lymph node to check how well the immune therapy worked, versus removing all the lymph nodes in that area as is currently standard.

The medication has proven very effective at shrinking melanoma tumors before surgery—and in some patients, it eliminates most of the cancer cells in the lymph nodes. This trial wants to know whether patients who have a strong response to this treatment can safely skip the more extensive surgery and still have excellent outcomes, potentially avoiding serious side effects like long-term fluid buildup in the arm or leg.