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Patients with resected stage II–III melanoma have approximately a 35% chance of death from their disease. Currently therapy is FDA-approved for patients with stage III disease and not for stage II disease, even though stage IIC patients die more frequently of melanoma than do patients with stage IIIA or IIIB disease. A deeper understanding of the tumor immune microenvironment is required to improve staging and to stratify patients and identify factors leading to therapy resistance. There is also a need for better spatial phenotypic signatures beyond the well-established biomarkers, to determine which high-risk stage II patients may benefit from adjuvant immunotherapy. We evaluated tumors from patients with high-risk, early-stage melanoma using quantitative multiplex immunofluorescence (qmIF) technology. Using a validated qmIF imaging workflow, we were able to identify individuals who would respond to adjuvant immunotherapy, better stratifying them into high-risk versus low-risk stage II melanoma. Standard staging, risk stratification, and patient treatment for early-stage melanoma is improved with qmIF and could be easily adapted to clinical testing in the future.
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