J.Jpn. Surg. Soc.. 127(2): 213-220, 2026

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Feature topic

SURGICAL TREATMENT IN THE ERA OF IMMUNE CHECKPOINT INHIBITORS: FOCUS ON CUTANEOUS MALIGNANCIES

The advent of immune checkpoint inhibitors (ICIs) has significantly advanced systemic therapy for dermatologic malignancies, making prognostic improvement through integration with surgical treatment a clinical reality. In melanoma, the efficacy of adjuvant PD-1 blockade with nivolumab or pembrolizumab is well established, particularly in stage IIB–III disease, and is now the standard of care. For cutaneous squamous cell carcinoma (cSCC), Merkel cell carcinoma, and epithelial skin cancers such as extramammary Paget’s disease, ICIs have gained insurance coverage in Japan for unresectable or recurrent advanced cases, offering valuable treatment options for rare tumors. In patients scheduled for or with prior ICI therapy, perioperative management requires close multidisciplinary coordination, especially regarding immune-related adverse events and optimal timing between surgery and systemic therapy. Beyond adjuvant use, salvage surgery after disease control with ICIs has shown utility, aiming to preserve function while achieving local control. Importantly, such surgical indications are expected to expand beyond melanoma as ICI applications broaden. This review summarizes current strategies combining ICIs with surgery, highlighting their complementary roles in improving outcomes for patients with skin cancers in the modern immunotherapy era.

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