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Melanoma

  • Antonio Maria Grimaldi
  • Paolo Antonio Ascierto
Chapter

Abstract

Melanoma is a malignant tumor that arises from melanocytic cells and primarily involves the skin. Early diagnosis is fundamental for surgical treatment of localized disease. A conservative surgical excision approach is favored with the extent based on the Breslow thickness. The search for the sentinel lymph node is fundamental for surgical staging, with risk of lymph node involvement directly proportional to thickness of the primary melanoma or the presence of mitosis. Complete lymph node dissection is indicated for metastases to clinically evident regional lymph nodes. Adjuvant systemic therapy is primarily interferon-α while new immunomodulating antibodies and targeted therapies may offer new options. When melanoma is unresectable or metastatic, immunotherapy and targeted therapy can have a significant impact on prognosis. Since 2011, the emergence of new immunomodulating and molecular targeted drugs has resulted in significant improvements in survival for patients with metastatic disease. In particular, the introduction of anti-CTLA-4 (ipilimumab) and anti-PD-1 immunotherapies (nivolumab, pembrolizumab) has been major turning point. The availability of new immunotherapies and targeted therapies has led to various combination regimens to further improve patient outcomes. Future developments will involve novel combinations that overcome resistance and/or reduce toxicity compared to current options.

Keywords

Melanoma Surgery Sentinel node Immunotherapy Targeted therapy Combination therapy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Antonio Maria Grimaldi
    • 1
  • Paolo Antonio Ascierto
    • 1
  1. 1.Melanoma, Cancer Immunotherapy and Development Therapeutics UnitIstituto Nazionale Tumori IRCCS Fondazione “G. Pascale”NaplesItaly

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