CTLA4 and metastatic neoplasm: Management of malignant melanoma depends on stage and disease burden. Surgical excision with negative margins remains the primary treatment for localized lesions [3,9]. Systemic therapy is the standard for advanced or metastatic disease, with PD-1 inhibitors such as nivolumab or pembrolizumab as first-line agents with or without a CTLA-4 inhibitors, while BRAF/MEK inhibitors are reserved for mutation-positive cases. Radiotherapy may provide local control in select situations, particularly if re-excision is not feasible.