This study is looking at how well two drugs, nivolumab and ipilimumab, work on advanced skin cancer called melanoma. Melanoma is a serious type of skin cancer. These drugs help the immune system fight cancer. A third substance, sargramostim, might be added to see if it helps even more. The study compares using nivolumab and ipilimumab with and without sargramostim to understand which combination works best and is safest. Some patients might get all three, while others get just the first two. They will also look at how smoking affects cancer treatment.

• The study may last up to 2 years, with follow-up for 5 years.
• Participants must visit the hospital every 3 weeks initially, then less often.
• Possible risks include side effects like tiredness or skin rashes.

To join, patients need to have advanced melanoma and meet health requirements like being over 18 and not pregnant. They must also not have other serious diseases or recent cancer treatments. This study helps us learn more about treating melanoma and might help future patients.