In this randomized, controlled, phase II trial, patients with pathologically confirmed treatment-naive unresectable or metastatic mucosal melanoma were stratified by PD-L1 expression...At a median follow-up of 6.60 months, patients receiving T+A had a higher median PFS (5.83 vs 2.80 vs 1.40 months; HR = 0.538; 95% CI, 0.237 to 1.221; HR = 0.444; 95% CI, 0.182 to 1.081; P = 0.170), ORR (35.3% (29.7% if including crossover patients ) vs 17.6% vs 8.3%), DOR (82.4% (70.3% if including crossover patients) vs 52.9% vs 58.3%) versus T or A group. Toripalimab plus axitinib showed promising antitumor activity versus toripalimab or axitinib alone in patients with treatment-naive unresectable or metastatic mucosal melanoma.