Adjuvant and neoadjuvant immunotherapy for acral and mucosal melanoma

<h2>Abstract</h2> Significant advancements have been made in the treatment of cutaneous melanoma over the past decade, particularly with the effectiveness of immune checkpoint inhibitors (ICIs) in advanced and adjuvant stages. However, the efficacy of ICIs for non-Caucasian populations and the rare clinical subtypes acral melanoma (AM) and mucosal melanoma (MM), has gradually been recognized to be lower in the advanced setting than cutaneous melanoma, suggesting that the use of ICIs in treating AM and MM need careful consideration in terms of ethnic and disease-specific factors to optimize outcomes in the adjuvant and neoadjuvant setting. However, the efficacy of adjuvant and neoadjuvant ICIs for AM and MM remains unclear. Therefore, in this review, we discussed the latest study updates on adjuvant and neoadjuvant therapies for AM and MM, focusing on anti-PD-1 antibody-based therapies. Our findings revealed that the efficacy of adjuvant and neoadjuvant therapy with anti-programmed death-1 receptor (anti-PD-1) antibody-based therapies for cutaneous melanoma is promising; however, their effectiveness varies according to ethnicity and melanoma subtype. There are several ongoing clinical trials on adjuvant and neoadjuvant therapies targeting AM or MM, which will provide the future perspectives of the strategy in the adjuvant and neoadjuvant settings for these rare melanoma subtypes.