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NewsMinimal residual disease (MRD) testing could help identify which stage IIB/IIC melanoma patients are most at risk for recurrence, but experts say the data isn't ready for routine clinical use. While ctDNA positivity has been linked to worse outcomes in small studies, detection rates remain low (11–16%) due to limited tumor burden. Prospective trials are urgently needed before MRD testing can guide adjuvant therapy or surveillance decisions.
Stage IIB and IIC melanoma carry recurrence risks of 24–46%, with most stage IIC relapses being distant metastases — outcomes that rival stage IIIB disease. While adjuvant PD-1 therapies like pembrolizumab and nivolumab have improved recurrence-free survival in these patients, they come with toxicities and don't benefit everyone. That's sparked interest in minimal residual disease (MRD) testing — particularly circulating tumor DNA (ctDNA) — as a way to identify who actually needs treatment after surgery.
The early data are intriguing but limited. Studies show ctDNA positivity is a strong prognostic signal for worse recurrence-free and overall survival, but detection rates in stage IIB/IIC patients are low (11–16%) due to minimal tumor shedding. One large retrospective study found ctDNA positivity carried a hazard ratio of 25.36 for shorter recurrence-free survival — the strongest prognostic factor identified. Still, stage II patients make up only a small fraction of existing trial populations, and no prospective data yet confirm that ctDNA-guided management improves outcomes.
Key Takeaways:
Why it matters: MRD testing has the potential to personalize melanoma care — sparing low-risk patients from unnecessary treatment while flagging those who need more aggressive intervention. But without prospective trial data specific to stage IIB/IIC disease, it's not ready for routine clinical decision-making.
