The majority (n= 16) were multicentre Adjuvant immune checkpoint inhibitors Description of studiesġ5 RCTs, four cross-sectional studies, four cohort studies, two qualitative studies, one case control study and one a mixed-methods study with qualitative and cross-sectional components were included (Table 2). Two papers referred to the same study (CHECKMATE 067). 1614 papers were identified by the search, 51 full texts were assessed for eligibility, and 28 papers describing 27 studies were included. Study selection procedures are shown in Figure 1. This mixed-methods systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Statement and registered to the Prospective Register of Systematic Reviews (PROSPERO) (CRD: 42022322481). In recent years the OS has significantly improved with the advent of immune checkpoint inhibitors (ICI) targeting cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and programmed death-1 (PD-1) and targeted therapy (TT) such as BRAF and MEK inhibitors, which target the mitogen-activated protein kinase pathway. Historically, the prognosis for people with stage IV cutaneous melanoma was poor with a median overall survival (OS) of 6-9 months and a 5-year overall survival of just 7%.
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