How would you approach the treatment of a patient with a history of cutaneous melanoma and only overt site of disease being a bulky level III axillary lymph node?  

Surgery and postop RT.

Therapeutic lymphadenectomy with or without adjuvant radiation therapy. There may be a role for targeted therapy depending on the mutation profile of the tumor.

The bulky local problem is only the tip of the iceberg. I would test for BRAF mutation. I would consider first neoadjuvant therapy with NIVO/IPI or if BRAF mutated, there are three possible combination of drugs to use if patient has had prior exposure to IO. If there is a good response to neoadjuvan...