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The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5-7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment for brain metastases. The expert panel was divided into five working groups to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of metastatic melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript., Competing Interests: Disclosure AA consultancy to and travel support from Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Roche; PAA consultancy to Amgen, Array, Bristol-Myers Squibb, Genmab, Idera, Immunocore, Incyte, MedImmune, Merck Sharp & Dohme, NewLink Genetics, Novartis, Pierre Fabre, Roche Genentech, Sandoz, Sanofi, Sindax, Sun Pharma, Ultimovacs; contracted research for Array, Bristol-Myers Squibb, Roche; travel support from Merck Sharp & Dohme; CUB advisor to Bristol-Myers Squibb, Merck Sharp & Dohme, Roche, Novartis, GlaxoSmithKline, AstraZeneca, Pfizer, Lilly, Genmab, Pierre Fabre, Third Rock Ventures; research funding from Bristol-Myers Squibb, Novartis, NanoString; Stock ownership in Uniti Cars; cofounder of Immagene BV; VCS travel support from Bristol-Myers Squibb, Pierre Fabre; advisory boards for Pierre Fabre; invited speaker for Novartis, Merck-Serono, Sanofi; MD honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; travel support from Merck Sharp & Dohme, Novartis; access to virtual conference services from Merck Sharp & Dohme; RD consultancy to and/or advisory relationships with Amgen, Bristol-Myers Squibb, CatalYm, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sanofi, Second Genome, Sun Pharma, Takeda; MBF advisory boards for Amgen, Array Bioscience, Bristol-Myers Squibb, Novartis, Pulse Bioscience, Sanofi; consultancy to Delcath Systems; CG-M travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; speaker honorarium from Bristol-Myers Squibb; HG consultancy to and/or advisory relationships with Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre-Fabre, Roche; institutional research grants from Bristol-Myers Squibb, Merck Sharp & Dohme; JJG advisory relationships with Amgen, Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi; JH consultancy, advisory boards and/or lectures for Amgen, AstraZeneca/Medimmune, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Ipsen, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche/Genentech, Sanofi, Seattle Genetics; scientific advisory boards for Achilles Therapeutics, AIMM Therapeutics, Celsius Therapeutics, Immunocore, Neogene Therapeutics, Neon Therapeutics, Vaximm; institutional research grants from Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Neon Therapeutics; CH consultancy, advisory boards and/or lectures for Amgen, AstraZeneca, Bristol-Myers Squibb, Inzyte, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; UK consultancy, advisory boards and/or lectures for Amgen, AstraZeneca/Medimmune, Bayer, Bristol-Myers Squibb, Glycotope, GlaxoSmithKline, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche/Genentech, Sanofi; institutional research grants from AstraZeneca/Medimmune, Bayer; CL consultancy, advisory boards, speakers bureau and/or advisory relationships with Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; advisory board for Avantis Medical Systems; travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; other honoraria from Incyte, Pierre Fabre, Pfizer; PL sponsored research for Bristol-Myers Squibb; speaker bureau for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre; paid advisor to Amgen, Bristol-Myers Squibb, MelaGenix, Merck Sharp & Dohme, Novartis, Pierre Fabre; travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; IL sponsored research for Amgen, Bristol-Myers Squibb, Janssen, Merck, Novartis, Roche, Microgenics; travel support from Bristol-Myers Squibb, Roche; MM advisory boards for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; research grants from Novartis, Roche; IM-R advisory boards for Amgen, Bioncotech, Bristol-Myers Squibb, Incyte, Merck Serono, Merck Sharp & Dohme, Novartis, Pierre Fabre, Regeneron, Roche, Sanofi; travel and congress accommodation support from Bioncotech, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; OM honoraria from Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; PN advisory boards and/or speakers bureau for AstraZeneca, Bristol-Myers Squibb, Immunocore, Ipsen, Merck, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; BN advisory boards, public speaking and consultancy for AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; research funding for institution from Merck-Serono, Novartis, Pfizer, Roche; ROB research grants from AstraZeneca; speaker honoraria from Pfizer, Roche; advisory boards for Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme; SP grants, personal fees and nonfinancial support from Almirall, Sanofi, ISDIN, La Roche Posay; grants and personal fees from Amgen, Leo Pharma, OJER Pharma; nonfinancial support from Lilly, AbbVie; personal fees from Bristol-Myers Squibb; grants from Novartis, Sun Pharma, MELAGENICS, Castle; personal fees and nonfinancial support from Pfizer, Roche; CR consultancy to and/or advisory boards for Amgen, Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sanofi; PR speakers bureau for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; advisory boards for Amgen, Blueprint Medicines, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre; BS honoraria from Amgen, Bristol-Myers Squibb, Incyte, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; grants from Bristol-Myers Squibb, Merck Sharp & Dohme, Pierre Fabre; VKS consultancy to and/or advisory boards for Bristol-Myers Squibb, Merck, Novartis, Regeneron; data safety monitoring boards for Array, Bristol-Myers Squibb, Novartis, Pfizer, Polynoma; HT advisory relationships with Bristol-Myers Squibb, Merck, Novartis, Roche/Genentech; research grants from Bristol-Myers Squibb, GlaxoSmithKline, Merck, Novartis, Roche/Genentech; AT travel and congress registration support from Agenus; AvA honoraria paid to institute for consultancy to and/or advisory boards for 4SC, Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Merck-Pfizer, Novartis; institutional research grants from Amgen, Bristol-Myers Squibb, Novartis. All remaining authors have declared no conflict of interest., (Copyright © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)

The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5-7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were: (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment of brain metastases. The expert panel was divided into five working groups in order to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of locoregional melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript., Competing Interests: Disclosure AA consultancy to and travel support from Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Roche; PAA consultancy to Amgen, Array, Bristol-Myers Squibb, Genmab, Idera, Immunocore, Incyte, MedImmune, Merck Sharp & Dohme, Newlinks Genetics, Novartis, Pierre Fabre, Roche Genentech, Sandoz, Sanofi, Sindax, Sun Pharma, Ultimovacs; contracted research for Array, Bristol-Myers Squibb, Roche; travel support from Merck Sharp & Dohme; CB adviser to Bristol-Myers Squibb, Merck Sharp & Dohme, Roche, Novartis, GlaxoSmithKline, AstraZeneca, Pfizer, Lilly, Genmab, Pierre Fabre, Third Rock Ventures; research funding from Bristol-Myers Squibb, Novartis, Nanostring; stock ownership in Uniti Cars; co-founder of Immagene BV; VCS travel support from Bristol-Myers Squibb, Pierre Fabre; advisory boards for Pierre Fabre; invited speaker for Novartis, Merck Serono, Sanofi; MD honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; travel support from Merck Sharp & Dohme, Novartis; access to virtual conference services from Merck Sharp & Dohme; RD consultancy to and/or advisory relationships with Amgen, Bristol-Myers Squibb, CatalYm, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sanofi, Second Genome, Sun Pharma, Takeda; MF advisory boards for Amgen, Array Bioscience, Bristol-Myers Squibb, Novartis, Pulse Bioscience, Sanofi; consultancy to Delcath Systems; CG-M travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; speaker honorarium from Bristol-Myers Squibb; HG consultancy to and/or advisory relationships with Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; institutional research grants from Bristol-Myers Squibb, Merck Sharp & Dohme; J-JG advisory relationships with Amgen, Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi; JH consultancy, advisory boards and/or lectures for Amgen, AstraZeneca/Medimmune, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Ipsen, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche/Genentech, Sanofi, Seattle Genetics; scientific advisory boards for Achilles Therapeutics, AIMM Therapeutics, Celsius Therapeutics, Immunocore, Neogene Therapeutics, Neon Therapeutics, Vaximm; institutional research grants from Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Neon Therapeutics; CH consultancy, advisory boards and/or lectures for Amgen, AstraZeneca, Bristol-Myers Squibb, Inzyte, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; UK consultancy, advisory boards and/or lectures for Amgen, AstraZeneca/Medimmune, Bayer, Bristol-Myers Squibb, Glycotope, GlaxoSmithKline, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche/Genentech, Sanofi; institutional research grants from AstraZeneca/Medimmune, Bayer; CL consultancy, advisory boards, speakers bureau and/or advisory relationships with Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; advisory board for Avantis Medical Systems; travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; other honoraria from Incyte, Pierre Fabre, Pfizer; PL sponsored research for Bristol-Myers Squibb; speaker bureau for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre; paid advisor to Amgen, Bristol-Myers Squibb, MelaGenix, Merck Sharp & Dohme, Novartis, Pierre Fabre; travel support from Bristol-Myers Squibb, Merck Sharp & Dohme; IL sponsored research for Amgen, Bristol-Myers Squibb, Janssen, Merck, Novartis, Roche, Microgenics; travel support from Bristol-Myers Squibb, Roche; MM advisory boards for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; research grants from Novartis, Roche; IM-R advisory boards for Amgen, Bioncotech, Bristol-Myers Squibb, Incyte, Merck Serono, Merck Sharp & Dohme, Novartis, Pierre Fabre, Regeneron, Roche, Sanofi; travel and congress accommodation support from Bioncotech, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; OM honoraria from Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche; PN advisory boards and/or speakers bureau for AstraZeneca, Bristol-Myers Squibb, Immunocore, Ipsen, Merck, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; BN advisory boards, public speaking and consultancy for AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Roche; research funding for institution from Merck Serono, Novartis, Pfizer, Roche; ROB research grants from AstraZeneca; speaker honoraria from Pfizer, Roche; advisory boards for Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme; SP grants, personal fees and non-financial support from Almirall, Sanofi, ISDIN, La Roche Posay; grants and personal fees from Amgen, Leo Pharma, OJER Pharma; non-financial support from Lilly, AbbVie; personal fees from Bristol-Myers Squibb; grants from Novartis, Sun Pharma, Melagenics, Castle; personal fees and non-financial support from Pfizer, Roche; CR consultancy to and/or advisory boards for Amgen, Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sanofi; PR speakers bureau for Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; advisory boards for Amgen, Blueprint Medicines, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre; BS honoraria from Amgen, Bristol-Myers Squibb, Incyte, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Roche; grants from Bristol-Myers Squibb, Merck Sharp & Dohme, Pierre Fabre; VS consultancy to and/or advisory boards for Bristol-Myers Squibb, Merck, Novartis, Regeneron; data safety monitoring boards for Array, Bristol-Myers Squibb, Novartis, Pfizer, Polynoma; HT advisory relationships with Bristol-Myers Squibb, Merck, Novartis, Roche/Genentech; research grants from Bristol-Myers Squibb, GlaxoSmithKline, Merck, Novartis, Roche/Genentech; AT travel and congress registration support from Agenus; AvA honoraria paid to institute for consultancy to and/or advisory boards for 4SC, Amgen, Bristol-Myers Squibb, Merck Sharp & Dohme, Merck-Pfizer, Novartis; institutional research grants from Amgen, Bristol-Myers Squibb, Novartis; all remaining authors have declared no conflicts of interest., (Copyright © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)