患有皮肤恶性肿瘤和局部受累的患者是疾病复发的高危人群，即使他们接受了最佳的手术和辅助治疗。在这里，我们讨论新辅助治疗如何比辅助治疗具有显着优势，进一步改善一些皮肤癌患者的预后，包括黑色素瘤、默克尔细胞癌和皮肤鳞状细胞癌。临床前研究和体内试验都表明，手术切除前接受免疫治疗可以引发更广泛、更强大的免疫反应，从而增加肿瘤细胞抗原呈递并改善免疫细胞的靶向性，从而可能产生优异的结果。此外，除了加速药物开发之外，新辅助方法还有可能提供一个平台来评估切除病灶的病理反应、优化预后并实现个性化适应性管理。然而，仍需要更多数据来确定理想的患者选择和最佳治疗框架，并确定治疗反应的可靠生物标志物。尽管关于新辅助治疗仍存在疑问，但目前的数据支持将新辅助治疗作为选择高危皮肤肿瘤患者的标准方法的范式转变。

Patients with cutaneous malignancies and locoregional involvement represent a high-risk population for disease recurrence, even if they receive optimal surgery and adjuvant treatment. Here, we discuss how neoadjuvant therapy has the potential to offer significant advantages over adjuvant treatment, further improving outcomes in some patients with skin cancers, including melanoma, Merkel cell carcinoma, and cutaneous squamous-cell carcinoma. Both preclinical studies and in vivo trials have demonstrated that exposure to immunotherapy prior to surgical resection can trigger a broader and more robust immune response, resulting in increased tumor cell antigen presentation and improved targeting by immune cells, potentially resulting in superior outcomes. In addition, neoadjuvant approaches hold the possibility of providing a platform for evaluating pathological responses in the resected lesion, optimizing the prognosis and enabling personalized adaptive management, in addition to expedited drug development. However, more data are still needed to determine the ideal patient selection and the best treatment framework and to identify reliable biomarkers of treatment responses. Although there are ongoing questions regarding neoadjuvant treatment, current data support a paradigm shift toward considering neoadjuvant therapy as the standard approach for selecting patients with high-risk skin tumors.