CTLA4 and metastatic neoplasm: They recommend to perform additional testing and imaging only when (distant) recurrent disease is suspected.7,13,14,32 For patients with local, regional, or metastatic disease, various treatment options are available, namely systemic treatment options such as BRAF/MEK inhibitors, and immunologic strategies with CTLA4, PD-1/PD-L1 antagonists that result in significantly improved survival rates33