American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which treatment is used as adjuvant therapy for high-risk nonmetastatic melanoma patients?

Chemotherapy with dacarbazine
High-dose interferon alfa
BRAF inhibitors
Ipilimumab

The correct answer is: High-dose interferon alfa

The use of high-dose interferon alfa as an adjuvant therapy for high-risk nonmetastatic melanoma patients is based on its ability to enhance immune response against tumor cells following surgical resection. Interferon alfa works by activating the immune system, which can help prevent recurrence of melanoma in high-risk patients after their initial treatment. Clinical trials have demonstrated that high-dose interferon can improve disease-free survival rates in these patients, making it a standard approach in the adjuvant setting for nonmetastatic melanoma. Other treatments mentioned, such as chemotherapy with dacarbazine, are not typically used for this purpose, as chemotherapy's effectiveness in melanoma has been limited compared to immunotherapy options. BRAF inhibitors are specifically indicated for patients with BRAF V600 mutation-positive melanoma and are not used as adjuvant therapy in nonmetastatic settings without metastasis. Ipilimumab, while an important immunotherapy agent, has a different mechanism of action and is generally reserved for advanced or metastatic melanoma rather than as an adjuvant treatment for high-risk nonmetastatic cases.