Adjuvant/Neoadjuvant Immunotherapy in Melanoma Based on Serial Plasma ctDNA Monitoring

Inclusion Criteria:

* Age ≥18 years
* Histologically confirmed melanoma (excluding uveal melanoma)
* Neoadjuvant Cohort: Surgically resectable AJCC 8th edition Stage III or Stage IV melanoma
* Adjuvant Cohort: Completely resected AJCC 8th edition Stage IIB, IIC, III, or IV melanoma
* ECOG Performance Status ≤2
* Adequate organ function: AST and ALT ≤5 × upper limit of normal (ULN) and Creatinine ≤2 × ULN.
* Baseline imaging obtained within 28 days prior to treatment initiation
* Negative pregnancy test for women of childbearing potential
* Ability to understand and sign informed consent

Exclusion Criteria:

* Prior anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-CTLA-4 therapy within 1 year before enrollment
* Contraindication to nivolumab and/or ipilimumab
* Active autoimmune disease requiring systemic immunosuppressive therapy
* Concurrent malignancy requiring active treatment that could interfere with study treatment or assessments
* Unresectable disease
* Uveal melanoma
* Any medical, psychiatric, or social condition that would interfere with protocol compliance or study participation