Immune checkpoint inhibitors have transformed the treatment and outcomes of patients with melanoma. Combination therapies targeting the PD1 and CTLA4 immune checkpoints produce the longest median overall survival ever reported in patients with unresectable stage III and IV melanoma (72.1 months). These therapies are not benign, and toxicity can significantly impact quality of life – nearly 40% of melanoma patients develop chronic immunotherapy-related adverse events. The common use of these expensive drugs also adds substantial costs and care-related expenses to our health care system and some patients may be cured by surgery or neoadjuvant therapy alone and do not require additional drug therapy. Circulating tumour DNA (ctDNA) is a minimally invasive blood-based biomarker that offers an exciting opportunity to truly deliver personalized melanoma care. The inclusion of ctDNA monitoring into clinical care can transform how we monitor and manage melanoma patients, informing the timing and selection of therapies and improving patient outcomes. The clinical utility and limitations of implementing ctDNA analysis into melanoma clinical care will be discussed.