Translating ctDNA into cutaneous melanoma care: An international expert survey

Geidel G, Fekade N, Raabe K, Smit DJ, Adam L, Heidrich I, Rünger A, Kött J, Zell T, Amaral T, Ascierto PA, Corrie P, Dummer R, Eggermont A, Guo J, Hassel JC, Jalving M, Johnson DB, Kandolf L, Kirkwood JM, Lebbé C, Lee R, Long GV, Lorigan P, Malvehy J, Mangana J, Mohr P, Patel SP, Rizos H, Robert C, Schadendorf D, Sondak VK, Svane IM, Wainstein A, Zager JS, Pantel K, Hauschild A, Gebhardt C, Aarts MJ, Arance A, Asher N, Becker JC, Bhatia S, Blank CU, Block MS, Boutros C, Burton EM, Butler M, Carvajal RD, Davar D, Dervenis V, Donia M, Eigentler T, Fecher LA, Ferrucci PF, Forschner A, Gaide O, Gaudy-Marqueste C, Gavrilova I, Glitza Oliva IC, Goldinger SM, Gouda MA, Grabbe S, Guenova E, Gutzmer R, Hafner C, Hamid O, Helgadottir H, Heppt M, Hieken TJ, Hoeijmakers LL, HoellerHoeller C, Hyngstrom J, Jacobs C, Jalovcic-Suljevic A, Jang S, Khattak MA, Kee D, Kehrer H, Koelblinger P, Larkin J, Lau P, Leiter U, Livingstone E, Lipson EJ, Longo C, Luke JJ, Ma VT, Mandalà M, Maul LV, Mazilu L, Meier F, Mesti T, Munoz-Couselo E, Nakamura Y, Neyns B, Ocvirk J, Orlova K, Da Silva IP, Popovic A, Posch C, Postow MA, Puzanov I, Ramelyte E, Richtig E, Roberts-Thomson R, Rorive A, Rutkowski P, Rutten A, Samoylenko I, Shalamanova GK, Shaw HM, Shoushtari AN, Si L, Siano M, Tawbi H, Tietze JK, Sullivan R, Terheyden P, Ugurel S, Urbonas V, Van Akkooi AC, Van der Veldt AA, Young K, Zimmer L (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 239

Article Number: 116676

DOI: 10.1016/j.ejca.2026.116676

Abstract

Background Circulating tumor DNA (ctDNA) is a promising biomarker in melanoma, with higher sensitivity for tumor burden detection than conventional diagnostics. While well established in research, clinical routine implementation remains pending. Key global questions concern optimal clinical applications and barriers to adoption. Methods A web-based survey of 116 members of the Melanoma World Society Study Group assessed international expert opinions on ctDNA utility across predefined clinical scenarios. The questionnaire included 18 general questions on ctDNA use and 5 clinical vignettes with de-identified patient data and retrospectively obtained ctDNA results. Results ctDNA was rated most valuable for detecting minimal residual disease (mean score 3.63), surveillance of recurrent disease (3.85), and stage IV melanoma (3.82), with limited utility in early stages. Experts considered ctDNA superior to S100 and LDH for early relapse detection and identifying progressive disease. Most participants (80%) agreed that ctDNA correlates with radiographic response, and 82% favored its integration into routine follow-ups. In urgent high-tumor-burden settings, 82.8% would initiate BRAFi/MEKi therapy based on ctDNA if tissue analysis was pending, and 93.9% if unavailable. For central nervous system lesions, 62% did not support blood ctDNA, while 66% considered cerebrospinal fluid valuable. Pragmatic approaches with small to mid-size targeted panels and short turnaround times were preferred. Major barriers included the need for prospective trials (85%), standardized guidelines (83%), and reimbursement policies (82%). Conclusion Key opinion leaders regarded ctDNA as a valuable adjunct selected melanoma scenarios. Validation through prospective studies, guideline development, and reimbursement frameworks are essential for broader clinical implementation.

Authors with CRIS profile

Involved external institutions

UPMC Hillman Cancer Center United States (USA) (US) University of Wisconsin Carbone Cancer Center United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Ovidius Clinical Hospital Romania (RO) University of Texas MD Anderson Cancer Center United States (USA) (US) Universitätsmedizin Rostock Germany (DE) Massachusetts General Hospital United States (USA) (US) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universität Bielefeld Germany (DE) National Cancer Institute (NCI) United States (USA) (US) Melanoma Institute Australia Australia (AU) Erasmus University Medical Center (MC) Netherlands (NL) Royal Marsden Hospital / The Royal Marsden NHS Foundation Trust United Kingdom (GB) Universitätsklinikum Essen Germany (DE) University Hospital Ghent Belgium (BE) Clinical Center University of Sarajevo / Klinički centar Univerziteta u Sarajevu Bosnia And Herzegovina (BA) Inova Fairfax Hospital (IFH) United States (USA) (US) Fiona Stanley Hospital Australia (AU) Peter MacCallum Cancer Centre Australia (AU) Ordensklinikum Linz - Elisabethinen Austria (AT) Paracelsus Medizinische Privatuniversität Austria (AT) University of Sydney (USYD) Australia (AU) Memorial Sloan Kettering Cancer Center United States (USA) (US) Princess Alexandra Hospital Australia (AU) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Kepler Universitätsklinikum (KUK) Austria (AT) Johannes Wesling Klinikum Minden Germany (DE) Karl Landsteiner Privatuniversität für Gesundheitswissenschaften GmbH Austria (AT) The Angeles Clinic and Research Institute United States (USA) (US) Karolinska Institute Sweden (SE) Sidney Kimmel Comprehensive Cancer Center (SKCCC) United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Maastricht University Medical Center (UMC+) Netherlands (NL) Hospital Clínic de Barcelona Spain (ES) Università degli Studi di Modena e Reggio Emilia (UNIMORE) Italy (IT) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Institute for Oncology Ljubljana (OIL) Slovenia (SI) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Saitama Medical University International Medical Center / 埼玉医科大学国際医療センタ Japan (JP) Universitair Ziekenhuis Brussel Belgium (BE) Centre Paul Strauss (UNICANCER) France (FR) Università degli Studi di Napoli Federico II Italy (IT) Cambridge University Hospitals United Kingdom (GB) Linear Clinical Research Ltd Australia (AU) Rabin Medical Center / מרכז רפואי רבין‎‎ Israel (IL) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) Ruhr-Universität Bochum (RUB) Germany (DE) Copenhagen University Hospital Denmark (DK) University of Michigan United States (USA) (US) MultiMedica Spa Italy (IT) Universitätsklinikum Tübingen Germany (DE) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Aix-Marseille University / Aix-Marseille Université France (FR) Université Sorbonne Paris Cité France (FR) Christie NHS Foundation Trust United Kingdom (GB) University of Colorado Cancer Center United States (USA) (US) Macquarie University Australia (AU) University of Manchester United Kingdom (GB) Universitat de Barcelona (UB) / University of Barcelona Spain (ES) Elbe Kliniken Stade-Buxtehude Germany (DE) Institut Gustave-Roussy France (FR) H. Lee Moffitt Cancer Center & Research Institute United States (USA) (US) Faculdade Ciências Médicas de Minas Gerais (FCM-MG) Brazil (BR) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Beijing Cancer Hospital China (CN) University Clinical Center Niš / Универзитетски Клинички центар Ниш Serbia (RS) Medizinische Universität Wien Austria (AT) Roswell Park Cancer Institute United States (USA) (US) Medizinische Universität Graz Austria (AT) The Queen Elizabeth Hospital Australia (AU) Centre Hospitalier Universitaire de Liège (CHU Liège) Belgium (BE) Universitätsklinikum Heidelberg Germany (DE) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) Vanderbilt University United States (USA) (US) Military Medical Academy (Serbia) / Војномедицинска академија / Vojnomedicinska akademija (VMA) Serbia (RS) Charité - Universitätsmedizin Berlin Germany (DE) Mayo Clinic United States (USA) (US) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie Poland (PL) ZAS Hospitals / Ziekenhuis aan de Stroom Belgium (BE) Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI / NKI-AVL) Netherlands (NL) Rush University United States (USA) (US) N.N. Blokhin Russian Cancer Research Center / Российский онкологический научный центр им. Н. Н. Блохина Russian Federation (RU) University College London (UCL) United Kingdom (GB) Seeland Cancer Center Switzerland (CH) University of Washington United States (USA) (US) Princess Margaret Cancer Centre / Princess Margaret Hospital Canada (CA) Northwell Health United States (USA) (US)

How to cite

APA:

Geidel, G., Fekade, N., Raabe, K., Smit, D.J., Adam, L., Heidrich, I.,... Zimmer, L. (2026). Translating ctDNA into cutaneous melanoma care: An international expert survey. European Journal of Cancer, 239. https://doi.org/10.1016/j.ejca.2026.116676

MLA:

Geidel, Glenn, et al. "Translating ctDNA into cutaneous melanoma care: An international expert survey." European Journal of Cancer 239 (2026).

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