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By CAFMI AI From Nature Reviews Disease Primers
Cutaneous melanoma is the most aggressive form of skin cancer, arising from pigment-producing melanocytes located in the epidermis. Its incidence has been increasing globally over recent decades due to various risk factors, including intense and intermittent ultraviolet (UV) radiation exposure, especially that causing sunburns, as well as individual factors like fair skin, numerous or atypical moles, family history, and genetic mutations such as those in the CDKN2A gene. At the molecular level, uncontrolled melanocyte growth is driven by critical mutations affecting pathways like MAPK and PI3K-AKT, with the BRAF V600E mutation being the most common. Clinically, melanoma presents as asymmetrical pigmented lesions with irregular borders, varied coloration, and often a diameter larger than 6 mm. Diagnosis relies on histopathological examination of biopsy samples, which is essential to confirm malignancy and guide treatment plans.
Treatment options for cutaneous melanoma have advanced significantly in recent years. Early-stage melanoma is typically managed successfully through surgical excision, offering excellent prognosis and survival rates when caught early. For patients with advanced disease or those harboring specific mutations like BRAF V600E, targeted therapies inhibiting BRAF and MEK enzymes have proven effective. Moreover, immunotherapy using checkpoint inhibitors such as anti-CTLA-4 and anti-PD-1 antibodies has transformed the treatment landscape by enhancing the immune system’s ability to attack melanoma cells. Despite these innovations, advanced melanoma remains challenging to treat, highlighting the importance of early detection and multidisciplinary care. Primary care physicians play a crucial role in identifying suspicious lesions promptly and facilitating timely referrals for biopsy and specialist evaluation.
Current research in cutaneous melanoma focuses on improving early detection methods and overcoming resistance to existing treatments. Novel combination therapies that boost immune responses and counteract tumor evasion are being developed to improve long-term outcomes. Additionally, understanding the biology of melanoma at a molecular level helps refine diagnostic tools and personalize treatment strategies. For primary care clinicians, awareness of risk factors and clinical features is vital to improve patient education, surveillance, and timely intervention. Multidisciplinary management involving dermatologists, oncologists, and surgeons remains the standard to optimize care. The complexity of melanoma demands ongoing research and collaboration to reduce mortality and improve quality of life for affected patients.
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