Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040

The role of innate immune cells in modulating vascular dynamics in skin malignancies

A developing tumor relies heavily on blood vessels to supply oxygen and nutrients. As a result, angiogenesis, the formation of new blood vessels, supports tumor growth and progression. Similarly, lymphangiogenesis, the formation of new lymphatic vessels, plays a critical role in metastatic dissemination by providing pathways for malignant cells to spread. The tumor microenvironment is crucial for establishing and maintaining these vascular networks, with innate immune cells playing a key regulatory role. Notably, immune cells are specifically enriched in barrier tissues, such as the skin, emphasizing their importance in skin malignancies. Therefore, understanding their role in regulating angiogenesis and lymphangiogenesis is essential for developing novel therapeutic strategies. This review article explores how innate immune cells influence tumor vasculature and highlights the therapeutic potential that may arise from this knowledge.

Margins for Melanoma: Extent of Resection, Alternative Approaches, and Future Considerations

Melanoma surgical margins have undergone significant evolution over the past century. Wide local excision (WLE) remains the established standard-of-care for localized cutaneous melanoma and guidelines have been established via multiple randomized-controlled trials (RCTs). Mohs micrographic surgery (MMS) has gained popularity in the past 2 decades, and while data are promising with regards to recurrence rates and survival, the data remain largely retrospective. MMS is not currently recommended for invasive melanoma where standard WLE margins are feasible. Future RCTs assessing narrower margins will offer insight into long-term oncologic outcomes as well as improved postoperative recovery after WLE.

Clinical characteristics and prognostic factors in patients with malignant melanoma: A Chinese prospective cohort study

BACKGROUND

Melanoma is a highly malignant tumor that has an extremely poor prognosis. It is the primary cause of death among cutaneous malignancies, accounting for 75% of such fatalities; approximately 325000 new cases and 57000 deaths were reported worldwide in 2020. The main modalities for melanoma treatment include surgery, immunotherapy, targeted therapy, high-dose interferon, antitumor angiogenesis, chemotherapy, and radiotherapy. Due to China's special national conditions, the main pathological types and therapeutic effects are greatly different from those in Europe and the United States, so more studies are needed to determine the curative effects of such treatments in the Chinese population.

AIM

To explore their clinical characteristics, prognostic influencing factors and real-world data to provide a reference basis for further diagnosis and treatment.

METHODS

We collected pathological data from patients diagnosed with malignant melanoma in our hospital in recent years. Univariate analysis was conducted using the log-rank test, while multivariate analysis was performed with the Cox proportional hazard regression model. The survival rate was calculated using the Kaplan-Meier method.

RESULTS

The male-to-female patient ratio was 1.04: 1. Among the clinical classifications, melanoma of the limb accounted for 47.56% of cases, followed by melanoma of the skin (18.18%) and mucosal melanoma (18.05%). The 5-year survival rates for stage I-II, stage III, and stage IV patients were 54.65%, 37.88%, and 28.58%, respectively. Univariate analysis revealed that age, tumor stage, treatment mode, platelet count at the first visit, and lactate dehydrogenase (LDH) level were significantly related to patient survival. Patients with high LDH and high platelet counts exhibited significantly lower survival rates at 1 year, 3 years, and 5 years. Multivariate analysis demonstrated that tumor stage, chemotherapy, interferon therapy, and LDH level were independent risk factors affecting patient survival and prognosis. Compared to the mortality rates of patients who did not receive chemotherapy or interferon therapy, those of patients who received chemotherapy and interferon therapy were 30.0% and 44.5% lower, respectively. Additionally, patients with elevated LDH levels were 2.27 times more likely to die than patients with normal LDH levels.

CONCLUSION

Melanoma is highly malignant, and its prognosis is influenced by numerous factors, resulting in an overall poor prognosis. This study identified several factors that impact patient prognosis, providing a foundation for individualized comprehensive treatment.

Design, synthesis, and evaluation of 1,4-benzodioxane-hydrazone derivatives as potential therapeutics for skin cancer: In silico, in vitro, and in vivo studies

In the pursuit of novel chemotherapeutic agents for skin cancer, we synthesized a series of 1,4-benzodioxane-hydrazone derivatives (7a-l) using the Wolff-Kishner reaction. These compounds were initially screened against the NCI-60 oncological cell lines in a one-dose assay at 10 μM. Among them, compound 7e emerged as a potent inhibitor of cancer cell growth across 56 cell lines, with an average GI50 of 6.92 μM. Notably, it exhibited enhanced efficacy in melanoma cell lines, including MDA-MB-435, M14, SK-MEL-2, and UACC-62, with GI50 values of 0.20, 0.46, 0.57, and 0.27 μM, respectively. Apoptosis assay and cell cycle analysis studies revealed that compound 7e induced apoptosis and caused S-phase arrest in MDA-MB-435 cells. Furthermore, an in vitro enzyme inhibition assay against mTOR kinase yielded an IC50 of 5.47 μM, while molecular docking studies of compound 7e (docking score: -8.105 kcal/mol) supported its binding affinity. Compound 7e adhered to Lipinski's rule of five and displayed favourable ADMET properties. In vivo studies demonstrated its safety and efficacy in ameliorating skin cancer in a mice model when administered intraperitoneally at 20 mg/kg. Structure-activity relationships were established through in vitro, in vivo, molecular docking, and molecular dynamics analysis. Collectively, these findings highlight 1,4-benzodioxane-hydrazone derivatives as promising scaffold for the development of novel chemotherapeutic agents for skin cancer.

Predicting overall survival benefit in previously untreated, unresectable or metastatic melanoma from improvement in progression-free survival: a correlation meta-analysis

Objectives

To evaluate the association between the treatment effects on progression-free survival (PFS) and overall survival (OS) for previously untreated, unresectable or metastatic melanoma.

Methods

A systematic literature review identified eligible trials reporting PFS and OS. Bivariate random effects meta-analysis (BRMA) was performed to estimate the correlation between the hazard ratios (HRs) of OS (HROS) and PFS (HRPFS), and sample size-weighted linear regression (WLR) was used to estimate a surrogacy equation which predict the HROS from the HRPFS. Strength of the correlation obtained from BRMA and WLR models was assessed using published guidelines. Predictive performance of the WLR model was also evaluated internally by leave-one-out cross-validation (LOOCV) and externally against data from newly published trials. Further analyses included adjustments for BRAF mutation status, and restriction to phase III trials or trials evaluating immune checkpoint or BRAF/MEK inhibitors, without crossover or crossover-adjusted, or meeting proportional hazards assumption.

Results

BRMA and WLR estimated a correlation of 0.74 (95%CI: 0.51-0.87) and 0.81 (95%CI: 0.58-0.92), respectively. The estimated surrogacy equation derived from the WLR was lnHROS = -0.05 + 0.50 × lnHRPFS with a statistically non-significant intercept (95% CI: -0.14 - 0.03) and a statistically significant slope (95% CI: 0.35 - 0.65). The surrogacy equation derived from the BRMA was lnHROS = -0.11 + 0.36 × lnHRPFS with a statistically non-significant intercept (95% CI: -0.23 - 0.00) and a statistically significant slope (95% CI: 0.17 - 0.57). The predictive accuracy of the WLR was 95.8% in LOOCV. Across sensitivity analyses correlations between HRPFS and HROS were ≥0.77 and ≥0.85 based on BRMA and WLR, respectively, and the accuracy of the WLR model in LOOCV was ≥88%. When predicting HROS for newly published trials, the differences between the observed and model-predicted HROS's were <0.05.

Conclusions

Results suggest a clinically meaningful and moderate trial-level correlation between PFS and OS across all analyses. The analyses and high accuracy of the surrogacy equations shown in internal and external validations can enable earlier prediction of treatment effects on OS from the improvements on PFS for previously untreated unresectable or metastatic melanoma.

Tanshinone IIA promotes ferroptosis in cutaneous melanoma via STAT1-mediated upregulation of PTGS2 expression

BACKGROUND

Melanoma is highly aggressive, metastatic with a poor prognosis. Despite significant advances in targeted therapies and immunotherapies, their efficiency limited by drug resistance. Tanshinone IIA (Tan IIA), a bioactive compound derived from Traditional Chinese plant, exhibits significant anticancer potential, which still needs more research in its complex regulatory mechanisms.

PURPOSE

This study aimed to elucidate the putative targets and regulatory mechanisms of Tan IIA in anti-melanoma, with a focus on its role in inducing ferroptosis.

STUDY DESIGN

We designed the experiment to explore the effects of Tan IIA on melanoma through both in vitro and in vivo experiments and to investigate the underlying mechanisms through transcriptomics combining network pharmacology analysis.

METHOD

Ferroptosis monitored by Malondialdehyde (MDA), Fe2+, reactive oxygen species (ROS) and glutathione (GSH) in vivo and in vitro. RNA sequence was performed to explore the key regulatory pathways involved in Tan IIA-induced ferroptosis. Chromatin immunoprecipitation (ChIP) and Luciferase assays were used to validate transcription factor responsible for prostaglandin-endoperoxide synthase 2 (PTGS2) regulation. Additionally, RT-qPCR, western blot, IF, IHC were aimed to evaluate the expression of target gene.

RESULT

Tan IIA markedly suppresses melanoma growth in a xenograft model. The same effect performed on inhibition melanoma cells and promotion to ferroptosis with accumulation of ROS, MDA, and Fe²⁺levels and GSH consumption. RNA sequencing and public database analysis revealed that Tan IIA regulates PTGS2, the critical marker of ferroptosis, and PTGS2-knockdown attenuates Tan IIA -induced ferroptosis in melanoma cells. Furthermore, we identified that Tan IIA stimulate signal transducer and activator of transcription 1 (STAT1), a transcription factor, promoting PTGS2 expression and localized in the cell cytoplasm. Moreover, downregulation of the transcription factor STAT1 lead to PTGS2 downregulation and also inhibit ferroptosis in melanoma.

CONCLUSION

This study, the first to link Tan IIA-induced ferroptosis to the STAT1/PTGS2 axis in melanoma, identifies STAT1 and PTGS2 as novel therapeutic targets for melanoma, which demonstrates the potential of natural compounds Tan IIA in overcoming drug resistance and integrates traditional medicine with advanced molecular techniques for mechanistic exploration.

Incidence and survival of patients with melanoma in Colombia

BACKGROUND

Melanoma accounts for less than 2 % of all skin cancers but exhibits highly aggressive behaviour, rapidly leading to metastasis. Various individual and environmental risk factors are associated with its occurrence.

METHODS

A cohort study was conducted using data from the Integrated Social Protection Information System (SISPRO) of the Colombian Ministry of Health. Patients with newly diagnosed melanoma in 2019 were included. Demographic, clinical, and mortality characteristics were analysed, and crude and age- and sex-adjusted incidence rates were calculated. The association between the altitude of populations and melanoma rates was evaluated using Pearson's correlation coefficient and an analysis of variance. The Fine and Gray model was used to estimate survival.

RESULTS

In 2019, 5255 new cases of melanoma were reported in the health insurance system. The crude incidence rate was 22 cases per 100,000 inhabitants, and the age-adjusted incidence rate was 21. The overall three-year mortality rate was 18.8 %, with melanoma-attributable mortality at 7 %. As expected, the mortality rate was higher in patients with invasive melanoma, COPD, and among men. Melanoma rates were positively correlated with greater exposure to UV radiation, determined by the altitude of the municipalities.

CONCLUSION

Colombia has high melanoma incidence rates, with significant regional variations. UV radiation exposure and altitude are key factors.

Regional Therapies for Melanoma and Merkel Cell Carcinoma

Melanoma and Merkel cell carcinoma (MCC) have the potential to develop into advanced, regionally metastatic disease that is not always amenable to resection and is associated with a worse survival. Intralesional therapies, including oncolytic vaccines, xanthene dyes, immune modulating cytokines, and regional perfusions such as isolated limb infusion and perfusion, including isolated limb and hepatic perfusion and percutaneous hepatic perfusion, have been used in the treatment of advanced cutaneous and uveal melanoma and MCC. These therapies are effective and have a role in the multimodality treatment of these patients and may be synergistically used with conventional immune and targeted therapies.

Cytotoxicity of ZnO nanoparticles in human melanocyte cells in the presence or absence of UV radiation: A preliminary comparative study with TiO2 nanoparticles

Zinc oxide nanoparticles (ZnONPs) and titanium dioxide nanoparticles (TiO2NPs), due to their nanometric size and photostability, are increasingly used as ingredients in sunscreens to absorb and scatter UV radiation. However, the current state of knowledge is insufficient to guarantee their safety. Therefore, the objectives of this study were to evaluate the cytotoxicity of ZnONPs and TiO2NPs in the presence and absence of UV radiation in in vitro model of primary human melanocyte cells HEMas. Our research demonstrated that 47 nm TiO2NPs exhibited lower toxicity compared to 25 nm ZnONPs. ZnONPs (5-12.5 ppm) affect various intracellular processes, including cell membrane integrity, proliferative processes, and the induction of morphological changes in cells at the ultrastructural level, particularly in mitochondria. The study highlights intricate mechanisms of cell death induced by ZnONPs, revealing a multifaceted interplay between apoptosis and necrosis. Additionally, we indicate the potential role of intracellular calcium ion influx, notably triggered by ZnONPs, in driving cell toxicity. This influx is linked to endoplasmic reticulum (ER) dysfunction, ultimately leading to cell death, offering valuable insights into the underlying mechanisms of nanoparticle-induced toxicity. Importantly, the co-exposure of both ZnONPs and TiO2NPs with UV radiation (9 J/cm2) enhances the toxic effect on melanocyte cells, indicating an interaction between NPs and UV radiaton and raising potential concerns about their effects on melanocytes and overall skin health.

Global burden of cutaneous melanoma incidence attributable to ultraviolet radiation in 2022

Cutaneous melanoma (CM) accounted for around 331,700 cancer cases globally in 2022. Ultraviolet radiation (UVR) is a major CM risk factor. In this study, we update and improve global estimates of UVR-attributable CM cases. Population attributable fractions (PAFs) were calculated by age, sex, and country using GLOBOCAN 2022 national incidence estimates comparing to a minimally exposed Nordic 1930 birth cohort reference population. Adjustments for acral lentiginous melanoma were made to exclude non-UVR-associated melanomas. In sensitivity analyses, PAFs were recalculated with a theoretical minimally exposed 1903 South Thames, England birth cohort and world region-specific reference populations. An estimated 267,353 (95% uncertainty intervals [UI]: 242,818, 278,638) CM cases were UVR attributable globally in 2022. Males contributed to a larger proportion (57%, 151,921 out of 267,353) of UVR-attributable CMs. We found significant regional variation with the highest PAF observed in Australia/ New Zealand, Northern Europe, and North America, all with more than 95% CM cases UVR-attributable. Attributable age-standardized rates were highest in regions with populations of lighter skin color such as Australia/New Zealand, Northern Europe, and North America, with 75.68 (95%UI: 74.50, 76.86), 36.82 (95%UI: 36.38, 37.26) and 33.69 (95%UI: 33.47, 33.91) attributable cases per 100,000 people. By age group, the burden increased with age, with PAF of 76.39% (95%UI: 66.24, 81.01) among people aged 30-49 versus 86.13% (95%UI: 80.04, 88.99) among 70+ years. Most of the global CM burden in 2022 was UVR-attributable. Primary prevention through increasing sun safety awareness and affordable sun protection provision options is key to reducing CM.

Synergistic activity of S63845 and parthenolide to overcome acquired resistance to MEK1/2 inhibitor in melanoma cells: Mechanisms and therapeutic potential

Melanoma remains a global health challenge. While targeted therapy with BRAFV600/MEK inhibitors largely improved the survival and quality of life for advanced melanoma patients, most of them progress due to acquired resistance. Dynamic heterogeneity and phenotypic plasticity of resistant melanoma prompted us to use parthenolide, an agent with an assorted bioactivity profile in combination with agents targeting enhanced pro-survival capacity of resistant melanoma cells. Parthenolide was used in combination with S63845, ABT-263 and ABT-199, BH3-mimetics targeting anti-/pro-apoptotic protein interactions. These drug combinations were investigated in patient-derived drug-naïve melanoma cell lines, their trametinib-resistant counterparts displaying either dedifferentiation neural-crest-like phenotype (MITFlow/NGFRhigh) or differentiation phenotype (MITFhigh/NGFRlow), and trametinib-resistant cell lines undergoing the phenotype transition after trametinib withdrawal. While parthenolide reduces proliferation and increases senescent cell fraction accompanied with reduction of NF-κB activity and MITF expression, it does not trigger apoptosis in high percentages of melanoma cells. Combination of parthenolide with BH3-mimetics induces externalization of phosphatidylserine, most efficiently with S63845, an inhibitor of pro-survival MCL-1. Parthenolide and S63845 synergize to cause massive apoptosis regardless of melanoma cell phenotypes, which is associated with caspase-3/7 activation, H2AX phosphorylation, and PARP cleavage. Mechanistically, parthenolide combined with S63845 reduces the protein level of MCL-1, upregulates pro-apoptotic NOXA, and prevents S63845-induced reduction of NOXA protein. Collectively, massive apoptosis induced synergistically by parthenolide combined with S63845 in trametinib-resistant melanoma cells displaying various phenotypes justifies exploring the potential of this strategy as a future treatment option for patients with melanoma resistant to therapies targeting MAPK signaling.

Resistance to BRAF inhibitors drives melanoma sensitivity to Chk1 inhibition

BRAF inhibitor-resistant melanomas (BRAFiR) acquire (epi)genetic and functional alterations that enable them to evade alternative treatments. Identifying these alterations is critical to advancing treatment strategies. Here, we explored the effect of Chk1 inhibition (Chk1i) on BRAFiR cells, revealing higher sensitivity compared to treatment-naïve cells both in vitro and in vivo. Using FUCCI-labeling and time-lapse microscopy, we show that S phase progression is required for Chk1i-induced cytotoxicity in BRAFiR cells, but not in treatment-naïve cells. Replication stress markers, including reduced BrdU incorporation and increased phospho-RPA and γH2AX, were observed mostly in BRAFiR cells with increased sensitivity to Chk1i. Untreated BRAFiR cells exhibited upregulated DNA replication genes, reduced progressing forks and increased origin firing, suggesting intrinsic replication changes. MAPK pathway reactivation in treatment-naïve cells mimicked BRAFiR traits, increasing sensitivity to Chk1i. These findings indicate that Chk1i exploits elevated replication stress specifically in BRAFiR cells, highlighting its therapeutic potential in overcoming MAPK inhibitor resistance in BRAF600-mutant melanoma.

Double-sided niche regulation in skin stem cell and cancer: mechanisms and clinical applications

The niche microenvironment plays a crucial role in regulating the fate of normal skin stem cells (SSCs) and cancer stem cells (CSCs). Therapeutically targeting the CSC niche holds promise as an effective strategy; however, the dual effects of shared SSC niche signaling in CSCs have contributed to the aggressive characteristics of tumors and poor survival rates in skin cancer patients. The lack of a clear underlying mechanism has significantly hindered drug development for effective treatment. This article explores recent advances in understanding how niche factors regulate cell fate determination between skin stem cells and skin CSCs, along with their clinical implications. The dual roles of key components of the adhesive niche, including the dermo-epidermal junction and adherens junction, various cell types-especially immune cells and fibroblasts-as well as major signaling pathways such as Sonic hedgehog (Shh), Wingless-related integration site (Wnt)/β-catenin, YAP (Yes-associated protein)/TAZ (transcriptional coactivator with PDZ-binding motif), and Notch, are highlighted. Additionally, recent advances in clinical trials and drug development targeting these pathways are discussed. Overall, this review provides valuable insights into the complex interactions between skin cancer stem cells and their microenvironment, laying the groundwork for future research and clinical strategies.

Deep pixel-wise supervision for skin lesion classification

BACKGROUND

Utilizing automated systems for diagnosing malignant skin lesions promises to improve the early detection of skin diseases and increase patients' survival rates. However, current classification methods primarily focus on global features, often overlooking local patterns.

METHODS

We apply two training approaches to address this limitation: deep pixel-wise supervision using a constant map and deep mask pixel-wise supervision employing a segmentation mask. Both methods apply supervision to each pixel of the feature map of the network, providing guidance to hidden layers and encouraging the learning of reliable patterns for class distinction. Combining deep and pixel-wise supervision effectively directs the network's attention to lesions with high precision.

RESULTS

Our experiments, spanning binary and multiclass classification using ISIC and PH2 datasets, reveal enhanced accuracy and sensitivity. The proposed model achieves 90.7% and 90.5% accuracy for binary classification on ISIC 2017 and PH2 datasets, respectively, and 88% accuracy for nine-class classification on a combined ISIC 2019 and 2020 dataset.

CONCLUSION

Comparative evaluations demonstrate superior performance compared to state-of-the-art methods, validating the effectiveness of deep pixel-wise supervision for skin lesion classification.

A clinical-dermoscopic risk scoring model for early melanoma of the soles: The iDScore_plantar

BACKGROUND

Melanoma of the sole is an aggressive rare form, often diagnosed late. Plantar atypical nevi (pAN) are frequently misdiagnosed as plantar early melanomas (pEM) and therefore excised. Our aim was to develop a clinical-dermoscopic risk-scoring model to help discriminate these plantar atypical melanocytic lesions (pAMLs).

MATERIALS AND METHODS

We collected 490 pAMLs (98 pEM, 392 pAN) paired with histopathological diagnosis, dermoscopic and clinical image, maximum lesion diameter, plantar location and age and sex of the patient from 17 European centres. This plantar dataset was grouped into training (261), validation (174) and testing (55 pAMLs) subsets. European participants (104 dermatologists, 56 residents) performed a blinded tele-dermoscopic test, including intuitive diagnosis, pattern analysis, rating of case difficulty, diagnostic confidence assessment and management decision.

RESULTS

A total of 2887 dermoscopic evaluations were obtained. The iDScore_plantar model gave an average area under the receiver operating characteristic curve of 0.95 (against 0.77 for pattern analysis). It was composed of the sum of five scores (S) for the following items: maximum diameter 8-12 (S = 1)/>12 mm (S = 5); age 40-50 (S = 2)/>50 years (S = 5); location on heel (S4) or on toes/plantar eminence (S = 2); asymmetry of colours (S = 2) and/or asymmetry of structures (S = 1). 'Long/short follow-up, biopsy, excision' decisions were matched with four risk ranges: no risk (S = 0-3), low-medium risk (S = 4-8), medium-high risk (S = 9-12) and very high risk (S = 13-17). By applying the model, participants would have reduced the number of misdiagnosed pAN and the number of pAN excised by -25.5% and -27.7%, respectively, and would have increased the number of correctly diagnosed pEM by +18.5%, the number of pEM recommended for surgical excision by +8.5% and the number of pEM recommended directly for surgical excision instead of biopsy by +16.15%.

CONCLUSION

The iDScore_plantar model proved to be a simple scoring tool to help clinicians in assigning a progressive risk of malignancy to pAMLs.

Cost per outcome of nivolumab + relatlimab vs BRAF + MEK inhibitor combinations for first-line treatment of BRAF-mutant advanced melanoma

BACKGROUND

The National Comprehensive Cancer Network guidelines list combination immunotherapy as the preferred first-line (1L) treatment for unresectable or metastatic melanoma over BRAF and MEK inhibitor (BRAFi/MEKi) therapy, regardless of BRAF mutation status. However, the economic impact of 1L treatment with nivolumab plus relatlimab (NIVO + RELA) vs BRAFi/MEKi therapies for BRAF-mutated advanced melanoma has not been assessed.

OBJECTIVE

To compare the health care costs, cost per progression-free life-year (PFLY), and cost per life-year (LY) of NIVO + RELA vs dabrafenib plus trametinib (DAB + TRAM), encorafenib plus binimetinib (ENCO + BINI), and vemurafenib plus cobimetinib (VEM + COBI) as 1L treatment for BRAF-mutated, unresectable or metastatic melanoma.

METHODS

A cost-per-outcome model compared the economic value of NIVO + RELA vs each BRAFi/MEKi therapy. Clinical inputs were derived from previous matching-adjusted indirect comparisons using individual patient data from the BRAF-mutant subgroup of RELATIVITY-047 and published data pooled from COMBI-d, COMBI-v, COLUMBUS, and coBRIM. LYs, PFLYs per investigator, and treatment duration were estimated using the restricted mean survival time. Health care costs (2024 US dollars), including drug acquisition and administration costs, disease management costs over the preprogression and postprogression periods, and adverse event management costs, were calculated over 5 years. Several scenario analyses were performed, including adding subsequent treatment costs.

RESULTS

Over 5 years, NIVO + RELA was associated with improved PFLYs and LYs compared with DAB + TRAM (mean PFLY: 1.94 vs 1.82 years, mean LY: 3.41 vs 2.77 years), ENCO + BINI (1.87 vs 1.78 years and 3.40 vs 2.91 years, respectively), and VEM + COBI (2.12 vs 1.80 years and 3.39 vs 2.63 years). The estimated total costs over 5 years were lower for NIVO + RELA vs DAB + TRAM ($300,479 vs $519,770), ENCO + BINI ($343,996 vs $572,556), and VEM + COBI ($296,361 vs $317,851). Main cost drivers were drug acquisition and administration costs. NIVO + RELA had lower costs per PFLY and per LY than DAB + TRAM ($155,107 vs $285,617 and $88,203 vs $187,699, respectively); ENCO + BINI ($183,628 vs $322,113 and $101,151 vs $196,924); and VEM + COBI ($139,688 vs $176,645 and $87,315 vs $121,086). The sensitivity analyses' results supported the base-case results.

CONCLUSIONS

NIVO + RELA showed improved LYs and PFLYs at lower cost than all 3 BRAFi/MEKi comparators over 5 years. These results support the economic value of NIVO + RELA for patients with previously untreated, BRAF-mutated, unresectable or metastatic melanoma.

Bimetallic Plasmonic Nanozyme-Based Microneedle for Synergistic Ferroptosis Therapy of Melanoma

Melanoma is the most common malignant skin tumor, characterized by complexity, invasiveness, and heterogeneity. Conventional therapies often yield poor outcomes, posing significant clinical challenges. Here, a microneedle (MN) patch that integrates nanozyme and traditional Chinese medicine (TCM) for ferroptosis pathway-dependent combined therapy of melanoma is designed. To amplify therapeutic activity, a novel Au@MoS2 bimetallic plasmonic nanozyme (BPNzyme) is prepared through a simple aqueous synthesis strategy involving a two-step process. Owing to the synergy between heterostructures, this rationally designed BPNzyme exhibits significantly enhanced therapeutic characteristics, including near-infrared (NIR) photothermal effect, peroxidase-like activity, and glutathione peroxidase-like property, which can effectively reshape the tumor microenvironment and disrupt the redox homeostasis. Under the combined action of the TCM β-elemene (β-ELE) and NIR light, further enhancement of oxidative damage, lipid peroxidation, and glutathione peroxidase 4 expression downregulation are observed for skin tumor cells, validating the synergistic amplification of ferroptosis. Moreover, the transdermal delivery of BPNzyme and β-ELE using the soluble hyaluronic acid MN patch effectively achieves 99.8% tumor growth suppression without significant systemic toxicity in vivo. These findings highlight the potential of the rationally designed BPNzyme-based MN system as a promising innovative strategy for non-invasive, efficient, and safe combination therapy of melanoma.

Geospatial Analysis of Cutaneous Malignant Melanoma Epidemiology in Europe From 2017 to 2021

BACKGROUND

Cutaneous melanoma is the most aggressive form of skin cancer. Although some studies have explored the epidemiology of melanoma in Europe, there is limited data on its spatial distribution.

MATERIALS AND METHODS

A longitudinal ecological study was conducted to analyze melanoma incidence and mortality from 2017 to 2021 using data from the Global Burden of Disease database. Cases were identified using the International Classification of Diseases (ICD)-9 and ICD-10 codes for both sexes across four European geographical regions, excluding Russia. Age-standardized incidence and mortality rates were calculated. A distance-based spatial weights matrix was generated using GeoDa software to define neighborhood structure. Hotspot analysis of spatial clusters was conducted using the Getis-Ord Gi* statistic. Additionally, the mortality-to-incidence ratio was calculated.

RESULTS

Between 2017 and 2021, a total of 606,448 new melanoma cases were diagnosed in Europe. Both sexes exhibited higher incidence and mortality rates in Northern Europe. All rates were consistently lower in women. For both sexes, incidence hotspots were identified in Sweden, Denmark, the Netherlands, and the United Kingdom. In contrast, mortality hotspots are primarily observed in the Nordic countries, as well as in Eastern Europe. Incidence coldspots are predominantly found in southeastern Europe, whereas mortality coldspots are primarily concentrated in Spain and Portugal. The overall mortality-to-incidence ratio in Europe remained stable during the period, with an evident east-west gradient and higher mortality relative to incidence observed in Eastern Europe.

CONCLUSION

This analysis reveals distinct geographical patterns, characterized by a north-south gradient in incidence and mortality. In contrast, the mortality-to-incidence ratio follows an east-west gradient, highlighting significant disparities in healthcare access.

Updates in clinical trial-explored chemopreventive agents for cutaneous melanoma: mechanisms affecting melanocytes

Cutaneous melanoma is a highly aggressive skin cancer with rising incidence, driven by risk factors such as ultraviolet exposure, genetic predisposition, and immunosuppression. While surgical excision remains the primary treatment, interest in chemoprevention strategies is growing. Numerous natural and synthetic agents have shown preclinical promise, but evaluating their effectiveness is challenging due to their systemic effects on multiple cell types. This review provides a focused examination of the melanocyte-specific mechanisms of select agents that have been tested in clinical trials for melanoma chemoprevention. We discuss various molecular and cellular mechanisms driving the anti-melanoma properties of nonsteroidal anti-inflammatory drugs, statins, sulforaphane, vitamin D, and N-acetylcysteine. Despite promising preclinical and early clinical data, challenges remain regarding precise mechanisms, optimal dosing, long-term safety, and patient selection. Future research should focus on refining melanoma prevention strategies through well-designed clinical trials and personalized approaches integrating genetic and molecular risk factors.

Integrated bioinformatic analysis identifies GADD45B as an immune-related prognostic biomarker in skin cutaneous melanoma

Skin cutaneous melanoma (SKCM) arises from melanocytes and is an aggressive form of skin cancer. If left untreated, most melanomas will metastasize, posing a major health risk. GADD45B, a member of the GADD45 family, is known to be involved in DNA damage repair; however, its specific role in SKCM remains largely unclear. In this study, we comprehensively investigated the function of GADD45B in SKCM. By integrating 26 SKCM-related datasets from The Cancer Genome Atlas (TCGA), Cancer Cell Line Encyclopedia (CCLE), cBioPortal for Cancer Genomics (cBioPortal), Gene Expression Omnibus (GEO), and other databases, we conducted functional enrichment, immune infiltration, and single-cell analyses using R. Additionally, transcriptome sequencing of 30 human SKCM cell lines, phenotype characterization of 29 SKCM lines in vitro, and macrophage polarization analysis were performed. We found that GADD45B expression was significantly downregulated in SKCM patients compared to normal controls (p < 0.001), and higher GADD45B levels correlated with better prognosis (p < 0.05). GADD45B also showed high diagnostic accuracy, with an area under the curve (AUC) of 0.986. GO and KEGG analyses revealed a strong association between GADD45B and immune-related pathways. Gene Set Variation Analysis (GSVA) and single-cell sequencing suggested that GADD45B may serve as a novel immune checkpoint, predominantly expressed in macrophages and promoting M1 polarization. In vitro, overexpression of GADD45B significantly inhibited SKCM cell proliferation, potentially via suppression of the PI3K/Akt signaling pathway, and also reduced chemotherapy resistance. Furthermore, in vivo experiments using a xenograft mouse model demonstrated that GADD45B overexpression significantly suppressed tumor growth. Mice injected with GADD45B-overexpressing tumor cells exhibited smaller tumor volumes from day 15 onwards compared to controls, with markedly reduced tumor volume and weight at the endpoint. These results underscore the potential of GADD45B as an effective tumor suppressor in SKCM. In conclusion, our findings highlight GADD45B as a key regulator in SKCM progression, capable of restraining tumor cell proliferation and enhancing apoptosis. GADD45B holds promise as a novel diagnostic and prognostic biomarker and a potential target for SKCM immunotherapy.

Excision margins and prognosis in cutaneous melanoma: retrospective population-based cohort study

BACKGROUND

The impact of surgical excision margin size on the survival of patients with cutaneous melanoma (CM) is controversial. The aim of this study was to assess the impact of excision margins on patient outcomes.

METHODS

This retrospective population-based follow-up study analysed data from patients presenting with CM without extranodal disease. The linear distance of CM from the excision margin was assessed microscopically. Regarding overall and melanoma-specific survival estimates, Kaplan-Meier analysis, the Cox proportional hazards model, and the subdistribution hazard ratio of the Fine-Gray model were applied.

RESULTS

Of 3262 patients, a total of 2698 (82.7%) with pathological (p) T1-2 and 564 (17.3%) with pT3-4 CM underwent wide local excision. Multivariable analyses, adjusting for melanoma incidence cohort, age, sex, anatomical site, ulceration, histotype, mitotic count, and tumour-infiltrating lymphocytes, demonstrated that, in pT1-2 CM, surgical excision > 1.1 cm resulted in significant CM-specific survival benefit. In pT4 disease, a CM distance to the surgical margins of < 1.6 cm significantly lowered CM-specific survival.

CONCLUSION

This population-based study conducted in real-world clinical practice found that the prognosis of patients with pT1-2 CM may benefit from excision margins > 1.1 cm. In pT3-4 CM, margins < 1.6 cm were significantly associated with lower CM-specific survival rates. These findings highlight the need for further prospective studies to evaluate the safety of surgical excision margins in managing primary CM.

Review of Non-Invasive Imaging Technologies for Cutaneous Melanoma

Imaging technologies are constantly being developed to improve not only melanoma diagnosis, but also staging, treatment planning, and disease progression. We start with a description of how melanoma is characterized using histology, and then continue by discussing nearly two dozen different technologies, including systems currently used in medical practice and those in development. For each technology, we describe its method of operation, how it is or would be projected to be most commonly used in diagnosing and managing melanoma, and for systems in current use, we identify at least one current manufacturer. We also provide a table including the biomarkers identified by and main limitations associated with each technology and conclude by offering suggestions on specific characteristics that might best enhance a technology's potential for widespread clinical adoption.

MGAT3 and MGAT5 overexpression alters the protein cargo of extracellular vesicles released by metastatic melanoma cells

Extracellular vesicles (EVs) are potential non-invasive diagnostic, prognostic and therapeutic tools. Additionally, they are important contributors to tumorigenesis. Glycosylation has been found to modulate the composition of the EV proteome. Increased amounts of β1,6-branched N-glycans, synthesized by N-acetylglucosaminyltransferase V (GnT-V), are most commonly observed in melanoma and are associated with decreased cell adhesion and increased metastasis. The opposite effect is caused by the addition of bisecting GlcNAc by N-acetylglucosaminyltransferase III (GnT-III). To date, the impact of these enzymes on EV cargo in melanoma remains unexplored. Flow cytometry was used to study the surface glycosylation of genetic variants of WM266-4 melanoma cells with induced overexpression of GnT-III or GnT-V encoding genes (MGAT3 or MGAT5) and EVs released by these cells. LC-MS/MS proteomics was applied to analyze the effect of altered glycosylation on the proteome of released EVs, followed by detailed bioinformatic analysis. Flow cytometry analysis revealed dynamic changes in the surface glycosylation of EVs derived from melanoma cells overexpressing MGAT3 or MGAT5. Induced overexpression of MGAT3 or MGAT5 also caused significant changes in the proteome of EVs. The proteomic analysis identified a total of 1770 microvesicular and 704 exosomal proteins that play different roles in melanoma progression, including those with established diagnostic/prognostic potential and those closely associated with melanoma onset. Proteomic profiling of EVs derived from cells overexpressing MGAT3 and MGAT5 revealed functional changes in EV protein content driven by glycosylation modifications. The study presented a potential multifaced application of melanoma-derived EVs for diagnostic and prognostic purposes.

Assessment of the Influence of UVR in Cutaneous Melanoma

BACKGROUND

Although a role for ultraviolet radiation (UVR) in cutaneous malignant melanoma (CMM) development is accepted, there is debate over the magnitude and mechanisms given its association with intermittent but not chronic exposure.

OBJECTIVES

To assess new ideas and data on the subject, review some debated topics, bringing a molecular view to epidemiological observations.

METHODS

We reviewed some recent advances in the field of epidemiology and genetics, including phenome-wide association studies, evolutionary genetics related to skin cancer, and mechanisms of UVR-induced DNA adduct formation.

RESULTS

High rates of CMM are strongly correlated with light colored skin across the globe. CMM shares risk factors associated with UVR sensitivity with keratinocyte cancer (KC). CMM risk is dominated by MC1R, a gene regulating the proportions of black and red melanin produced. An emerging mutagenic mechanism involves reactive melanin, particularly red pheomelanin, that can itself induce DNA adducts.

CONCLUSION

Demographically, epidemiologically, and mechanistically, pigmentation status is central to CMM risk and a shared genetic susceptibility, comprising several pigmentation genes, between CMM and KCs. In the general population, CMM risk is associated with pale skin and poor tanning ability, mechanistically due to a relative lack of protection against UVR adduct formation, or perhaps via an alternate manner in individuals with abundant pheomelanin. Overall, evidence suggests that UVR exposure impacts CMM risk.

Characteristics of patients with melanoma with non‑melanoma skin cancer comorbidity: Practical implications based on a retrospective study

The co-occurrence of melanoma and non-melanoma skin cancer (NMSC) can lead to increased morbidity. However, there has been limited research into the dermoscopic characteristics of melanomas and clinical factors during co-occurrence. A total of 264 patients with melanoma, including 63 with NMSC comorbidity, were enrolled in the present study to retrospectively analyse the coexistence of melanoma morphology, as determined by dermoscopic examination, pathological report, tumour location and clinically manifested risk factors. The frequency of solar lentiginosis (SL) was compared between 264 patients with melanoma and 233 patients with NMSC without melanoma. In 83.4% of cases, skin cancer occurred before or concomitantly with the melanoma. The leading indicators of comorbidity were age (median 70 years; P<0.0001) and SL on the trunk and arms (P<0.0001). Melanomas in patients with NMSC comorbidity were significantly more frequently located on the head and neck [P<0.001; Bonferroni adjusted P-value (P-adj.)<0.01], then on the trunk, but less frequently occurred on the lower limbs (P<0.05). The dermoscopic multicomponent asymmetric pattern was the predominant pattern in both groups. The most characteristic pattern in the NMSC group was facial melanoma (P<0.005; P-adj.<0.05); the spitzoid pattern (P<0.001; P-adj.<0.01) was rare. Dermoscopic regression was more common (P<0.001) in the NMSC group. Regression and the number of nevi were independent of age. Differences in the incidence of SL were evaluated based on the presence of melanoma (P<0.01) and in patients without melanoma based on the presence of squamous cell carcinoma (SCC; P<0.01), multiple basal cell carcinoma (P<0.0001) and multiple SCC (P<0.005). Patients with melanoma were 10 years younger on average compared with patients with NMSC (P<0.0001). The differentiation factors identified in the present study may improve the precision of dermoscopic examinations and potentially lead to modifications in the diagnostic workflow for patients with multiple NMSCs with comorbid melanoma.

Habitat-based MRI radiomics to predict the origin of brain metastasis

BACKGROUND

This study aims to explore the value of habitat-based magnetic resonance imaging (MRI) radiomics for predicting the origin of brain metastasis (BM).

PURPOSE

To investigate whether habitat-based radiomics can identify the metastatic tumor type of BM and whether an imaging-based model that integrates the volume of peritumoral edema (VPE) can enhance predictive performance.

METHODS

A primary cohort was developed with 384 patients from two centers, which comprises 734 BM lesions. An independent cohort was developed with 28 patients from a third center, which comprises 70 BM lesions. All patients underwent T1-weighted contrast-enhanced (T1CE) and T2-weighted (T2W) MRI scans before treatment. Radiomics features were extracted from tumor active area (TAA) and peritumoral edema area (PEA) selected using the least absolute shrinkage and selection operator (LASSO) to construct radiomics signatures (Rads). The Rads were further integrated with VPE to build combined models for predicting the metastatic type of BM. Performance of the models were assessed through receiver operating characteristic (ROC) curve analysis.

RESULTS

Rads derived from TAA and PEA both showed predictive power for identifying the origin of BM. The developed combined models generated the best performance in the training (AUCs, lung cancer [LC]/non-lung cancer [NLC] vs. small cell lung cancer [SCLC]/non-small cell lung cancer [NSCLC] vs. breast cancer [BC]/gastrointestinal cancer [GIC], 0.870 vs. 0.946 vs. 0.886), internal validation (area under the receiver operating characteristic curves [AUCs], LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.786 vs. 0.863 vs. 0.836) and external validation (AUCs, LC /NLC vs. SCLC/NSCLC vs. BC/GIC, 0.805 vs. 0.877 vs. 0.774) cohort.

CONCLUSIONS

The developed habitat-based radiomics models can effectively identify the metastatic tumor type of BM and may be considered as a potential preoperative basis for timely treatment planning.

Prognostic Value of Nevus-Associated Melanoma in Patients with Melanoma

BACKGROUND

Although most melanomas develop de novo, about 30% are nevus-associated melanomas, where the prognostic value is unclear. Our study aimed to determine whether nevus-associated melanoma is associated with sentinel lymph node (SLN) status and prognosis in patients with melanoma.

METHODS

The Sentinel Lymph Node Working Group database, which includes comprehensive clinicopathological and outcome data, was utilized to investigate the association of nevus-associated melanoma with SLN status as well as relapse-free (RFS), melanoma-specific (MSS), and overall survival (OS) using multivariable logistic regression and Cox regression modeling.

RESULTS

A total of 3447 adult patients with a median follow-up of 2.6 years (interquartile range 0.9-6.9) were evaluable. Compared with de novo melanomas, nevus-associated melanomas showed a significant correlation with younger age as well as favorable histological features. The presence of a nevus-associated melanoma was not identified as an independent factor for SLN status (odds ratio 1.06, 95% confidence interval [CI] 0.80-1.41; p = 0.68). Compared with de novo melanomas, nevus-associated melanomas provided independent prognostic information for a favorable RFS (hazard ratio [HR] 0.67, 95% CI 0.53-0.84; p < 0.001), MSS (HR 0.54, 95% CI 0.34-0.85; p = 0.008), and OS (HR 0.42, 95% CI 0.30-0.57; p < 0.001).

CONCLUSION

Melanomas associated with pre-existing nevi appear to be an independent favorable prognostic factor for recurrence and survival and may potentially be used as a clinical parameter for identifying patients with lower risk of recurrence.

Exosomes in melanoma: Future potential for clinical theranostics

Melanoma, an aggressive form of skin cancer, presents significant therapeutic challenges due to its resistance to conventional treatments and propensity for metastasis. Exosomes, nanoscale vesicles secreted by a wide variety of cells, have emerged as promising tools for developing novel melanoma therapies. Exosome-based therapeutic approaches offer several advantages, including inherent biocompatibility, low immunogenicity, and the ability to cross biological barriers. This review explores the therapeutic potential of exosomes in melanoma treatment, focusing on their multifaceted roles in modulating tumor cell behavior, enhancing anti-tumor immune responses, and serving as targeted drug delivery vehicles. We discuss various strategies employed to engineer exosomes for enhanced therapeutic efficacy, including loading them with chemotherapeutic agents, small interfering RNAs (siRNAs), microRNAs (miRNAs), and immunomodulatory molecules. Additionally, we highlight the potential of exosomes derived from diverse sources to enhance anti-cancer effects. Furthermore, we address the challenges and future directions in translating exosome-based therapies from bench to bedside, emphasizing the need for standardized isolation and manufacturing protocols, as well as rigorous preclinical and clinical evaluations to unlock the full therapeutic potential of exosomes in the fight against melanoma.

Identification of Predictive Factors for the Development of In-Transit Metastasis in Patients with Melanoma

BACKGROUND

In patients with melanoma, in-transit metastasis (ITM) can develop. This study aimed to identify the risk for a first recurrence of ITM and associated predictive clinical factors in a large international cohort of patients with melanoma.

METHODS

Patients with primary cutaneous melanoma who underwent wide local excision (WLE) and sentinel lymph node biopsy (SLNB) were identified from the Sentinel Lymph Node Working Group (SLNWG) database between January 1993 and February 2023. Predictive factors for first recurrence of ITM were analyzed.

RESULTS

The study enrolled 7860 patients, and the median follow-up time was 47.1 months (interquartile range [IQR], 19.0-95.0 months). The risk for the development of ITM as a first recurrence was 4.12% (95% confidence interval [CI], 3.63-4.66%) at 5 years. The median time to first ITM recurrence was 15 months (IQR, 7.0-30.0 months). Significant clinicopathologic factors independently associated with an increased risk of ITM in multivariable analysis were increasing Breslow thickness (hazard ratio [HR], 1.37; 95% CI, 1.30-1.43; p < 0.0001), lower-extremity versus trunk melanoma (HR, 2.49; 95% CI, 1.86-3.32; p < 0.0001), increasing age (HR, 1.03; 95% CI, 1.02-1.04; p < 0.0001), number of positive sentinel lymph nodes (SLNs: 1 vs. 0 [HR, 2.24; 95% CI, 1.66-3.01; p < 0.0001] and 2 vs. 0 [HR, 2.37; 95% CI, 1.45-3.88; p = 0.0006]), and presence of vascular invasion (HR, 1.79; 95% CI, 1.21-2.64; p = 0.0035).

CONCLUSION

The independent risk factors for the development of ITM identified in a large international cohort of melanoma patients were Breslow thickness, lower-extremity melanoma, older age, number of positive SLNs, and presence of vascular invasion.

Global burden of non-melanoma skin cancers among older adults: a comprehensive analysis using machine learning approaches

Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), have shown significant global increases in burden, particularly among older adults, with wide regional, gender, and socio-demographic disparities. However, no previous study has comprehensively analyzed these trends using integrated multi-model approaches. A comprehensive analysis of global non-melanoma skin cancer (NMSC) data from 1990 to 2021 was performed, including trend analysis, frontier analysis, and decomposition analysis to compare the burden of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) across regions, genders, and socio-demographic groups. Temporal trends in incidence, prevalence, and disability-adjusted life years (DALYs) were identified using epidemiological decomposition techniques. To forecast future disease burden from 2022 to 2050, eight machine learning models (Prophet, ARIMA, TBATS, ElasticNet, ETS, VAR, HoltWinters, and Theta) were applied, and the most optimal predictive models for BCC and SCC were selected based on performance metrics. From 1990 to 2021, the global burden of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) among older adults increased substantially. The incidence of BCC rose by 291.85%, with an age-standardized rate (ASR) increase of 62.79%, while SCC incidence increased by 322.77%, with a 67.42% rise in ASR. High Socio-Demographic Index (SDI) regions showed the largest ASR increases for BCC (102.73%) and SCC (107.31%), whereas low SDI regions demonstrated more modest changes or declines (BCC: - 2.86%, SCC: - 3.08%). Gender disparities were observed, with males accounting for 56.47% of SCC cases globally. Decomposition analysis revealed that population growth was the primary driver of increased NMSC burden, contributing 62.52-83.92% of the rise in incidence and DALYs, while epidemiological changes accounted for up to 52.2% in high SDI regions. Frontier analysis highlighted significant regional disparities, with high SDI regions, such as North America, exhibiting the highest age-standardized incidence rates for BCC (2,923.22 per 100,000) and SCC (1,805.33 per 100,000), whereas low SDI regions, like sub-Saharan Africa, showed minimal burdens near frontier values. Finally, disease burden forecasting for 2022 to 2050 using machine learning models predicted a slight decrease in the incidence rates of BCC (from 314.00 to 308.73 per 100,000) and SCC (from 157.67 to 148.16 per 100,000). Disability-adjusted life years (DALYs) are projected to decline for SCC (79.32 to 75.20 per 100,000) but increase slightly for BCC (0.136 to 0.151 per 100,000). These projections underscore the need for tailored strategies to address the growing burden of NMSC. The growing global burden of NMSCs, particularly in high SDI regions and among older adults, underscores the urgent need for tailored prevention, resource allocation, and management strategies. Machine learning-based approaches provide robust insights into global trends and future challenges for BCC and SCC.

Oral Melanoma in Older Adults: Epidemiology, Molecular Landscape, and Treatment Strategies

Oral melanoma is an aggressive neoplasm arising from melanocytes in the mucosal epithelium, accounting for 0.2%-0.8% of all melanomas. Unlike cutaneous melanoma, it is not associated with UV exposure, and its pathogenesis involves complex genetic and molecular alterations. This neoplasm predominantly affects older adults (≥ 60 years). Clinically, lesions often present as macular or nodular with an exophytic growth pattern, sometimes ulcerated, and exhibit varied pigmentation. Diagnosis is further complicated by non-pigmented (amelanotic) variants that can resemble other oral pigmentations. Wide surgical excision remains the mainstay treatment, often combined with chemotherapy; however, recurrence and distant metastasis remain high. While immunotherapy has shown promise in other melanoma subtypes, its efficacy in oral melanoma remains uncertain. Treatment in older adults is particularly challenging due to comorbidities and treatment-related morbidity. This review summarizes the epidemiology, clinical features, and current treatment strategies for oral melanoma in older adults. Key advances in the molecular mechanisms underlying this neoplasm are also outlined. As a strategic approach, integrating oral melanoma screening into routine geriatric dental care, supported by diagnostic algorithms, may improve early detection, prognosis, and survival outcomes in this vulnerable population.

KLF12 transcriptional activation by a novel LncRNA A930015D03Rik enhances melanoma metastasis

Melanoma metastasis remains a poorly understood yet fatal hallmark of cancer progression, with limited therapeutic strategies targeting its underlying mechanisms. While the transcription factor KLF12 shows paradoxical roles across malignancies, its context-dependent functions in melanoma-particularly its regulatory interplay with extracellular vesicle (EV)-driven intercellular communication-have not been systematically explored. To address this gap, we investigated how metastatic melanoma cells exploit KLF12-mediated pathways through EV cargo transfer to propagate aggressive phenotypes. Our research results indicate that highly metastatic cells transfer lncRNA A930015D03Rik through exosomes, acting as a sponge for miR-204-5p, which promotes the expression of KLF12. The transcriptional activation of KLF12 facilitates the activation of critical pro-cancer pathways such as inflammation and NF-κB, while inhibiting the tumor-suppressive mechanisms of P53 and oxidative phosphorylation. This ultimately enhances the migration and invasion capabilities of low-metastatic tumor cells, driving the malignant progression of melanoma. In this study, we identified a novel tumor-derived EVs lncRNA, A930015D03Rik, which can enhance the expression of KLF12 through a ceRNA mechanism and influence the post-translational regulation of KLF12, thereby modulating the plasticity of tumor metastasis. This exosome-genome feedforward circuit explains KLF12's microenvironment-contingent pro-metastatic function, offering significant insights for the development of future therapeutic strategies targeting tumor metastasis.

Analysis and comparison of the trends in burden of malignant cutaneous melanoma in East Asian countries and regions and worldwide from 1991 to 2021

Objectives

This study aims to comprehensively analyze temporal trends in the burden of malignant melanoma (MM) in East Asia, focusing on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1991 to 2021. It further seeks to compare these trends with the global burden of disease.

Study design

The study utilized data from the Global Burden of Disease (GBD) database to examine the disease burden of MM across East Asian countries and regions, as well as globally, over a 30-year period (1991-2021).

Methods

We assessed changes in the incidence, prevalence, mortality, and DALYs associated with MM in East Asia and globally using GBD database open-source data. To capture the underlying trends in the disease burden, we applied the Joinpoint regression model to calculate the average annual percentage change (AAPC) and corresponding 95% confidence intervals (95% CI). A detailed comparative analysis was conducted to explore differences in the burden of MM across East Asian regions and compared with global trends, with particular emphasis on age, sex, and temporal changes.

Results

The greatest increase in MM incidence in East Asia was observed in Korea, where the age-standardized incidence rate (ASIR) rose from 0.603 cases per 100,000 population (95% CI: 0.389-0.789) in 1991 to 1.896 cases per 100,000 (95% CI: 0.78-2.499) in 2021. Regarding prevalence, China exhibited the most significant increase in East Asia, with the age-standardized prevalence rate (ASPR) increasing from 0.699 (95% CI: 0.451-0.864) per 100,000 in 1991 to 4.157 (95% CI: 2.195-5.633) per 100,000 in 2021. The highest increases in MM mortality and DALYs were noted in Taiwan Province of China, where the age-standardized mortality rate (ASMR) increased from 0.36 (95% CI: 0.339-0.382) per 100,000 in 1991 to 0.414 (95% CI: 0.414) per 100,000 in 2021. Similarly, the age-standardized DALY rate (ASDR) in Taiwan rose from 10.375 (95% CI: 9.781-11.049) per 100,000 in 1991 to 11.647 (95% CI: 10.558-12.478) per 100,000 in 2021. Age and gender exhibited distinct patterns of influence on the MM burden: while ASIR generally increased with age, ASPR initially increased and later plateaued. Both ASMR and ASDR demonstrated a positive correlation with age. Additionally, male populations consistently exhibited higher morbidity and mortality rates than females.

Conclusion

Over the period from 1991 to 2021, there were significant variations in the incidence, prevalence, mortality, and DALY rates of MM across East Asian countries and regions, including China, Japan, South Korea, North Korea, and Taiwan. These disparities underscore the need for region-specific, proactive prevention strategies and targeted public health interventions to mitigate the growing burden of malignant melanoma in the region.

Aptamer as a Molecular Tethering Agent Induces PrPC Aggregation and Degradation to Inhibit Melanoma Proliferation

Melanoma, a malignant tumor originating from melanocytes, is the most aggressive and deadly form of skin cancer. Previous studies have revealed that the cellular prion protein (PrPC) is frequently overexpressed in melanoma, contributing to tumor progression. This study presents the first proof of concept evidence that nucleic acid aptamers can be used to construct a molecular tethering agent that regulates PrPC protein levels by inducing membrane-bound PrPC aggregation for antimelanoma therapy. Using a screening strategy combining cell-SELEX and cell-internalization SELEX, we obtained ssDNA aptamer, TT-1e, specifically binding to melanoma cells and tissues. We identified that the binding site of TT-1e is located at the octapeptide repeat region of glycosylated PrPC. Based on the binding characteristics of TT-1e, we engineered an aptamer-based molecular tethering agent TTe-TTe. We found that TTe-TTe induces aggregation of cell surface PrPC, promoting its internalization and facilitating its lysosomal degradation. This process resulted in the inhibition of AKT pathway activation. Importantly, in vivo studies confirmed the ability of TTe-TTe to target melanoma xenografts and suppress tumor growth through this unique mechanism. Our study presents a promising strategy for targeted melanoma therapy and introduces a paradigm-shifting approach for manipulating protein levels using aptamers as molecular tethering agents.

Deciphering the role of liquid-liquid phase separation in sarcoma: Implications for pathogenesis and treatment

Liquid-liquid phase separation (LLPS) is a significant reversible and dynamic process in organisms. Cells form droplets that are distinct from membrane-bound cell organelles by phase separation to keep biochemical processes in order. Nevertheless, the pathological state of LLPS contributes to the progression of a variety of tumor-related pathogenic issues. Sarcoma is one kind of highly malignant tumor characterized by aggressive metastatic potential and resistance to conventional therapeutic agents. Despite the significant clinical relevance, research on phase separation in sarcomas currently faces several major challenges. These include the limited availability of sarcoma samples, insufficient attention from the research community, and the complex genetic heterogeneity of sarcomas. Recently, emerging evidence have elaborated the specific effects and pathways of phase separation on different sarcoma subtypes, including the effect of sarcoma fusion proteins and other physicochemical factors on phase separation. This review aims to summarize the multiple roles of phase separation in sarcoma and novel molecular inhibitors that target phase separation. These insights will broaden the understanding of the mechanisms concerning sarcoma and offer new perspectives for future therapeutic strategies.

Impact of fine-tuning parameters of convolutional neural network for skin cancer detection

Melanoma skin cancer is a deadly disease with a high mortality rate. A prompt diagnosis can aid in the treatment of the disease and potentially save the patient's life. Artificial intelligence methods can help diagnose cancer at a rapid speed. The literature has employed numerous Machine Learning (ML) and Deep Learning (DL) algorithms to detect skin cancer. ML algorithms perform well for small datasets but cannot comprehend larger ones. Conversely, DL algorithms exhibit strong performance on large datasets but misclassify when applied to smaller ones. We conduct extensive experiments using a convolutional neural network (CNN), varying its parameter values to determine which set of values yields the best performance measure. We discovered that adding layers, making each Conv2D layer have multiple filters, and getting rid of dropout layers greatly improves the accuracy of the classifiers, going from 62.5% to 85%. We have also discussed the parameters that have the potential to significantly impact the model's performance. This shows how powerful it is to fine-tune the parameters of a CNN-based model. These findings can assist researchers in fine-tuning their CNN-based models for use with skin cancer image datasets.

Mechanistic insights into proteasome inhibitor MG132 induced apoptosis in melanoma A375 cells

Despite advancements in melanoma therapy, the prognosis remains unfavorable for many patients. The proteasome inhibitor MG132 has shown therapeutic potential through pathway regulation, yet its precise mechanisms in melanoma require systematic elucidation. Using A375 melanoma cells, we conducted multi-modal investigations combining cytotoxicity assessment (CCK8), migration analysis (wound healing), apoptosis quantification (flow cytometry), and proteomic profiling (western blot) to dissect MG132's molecular mechanisms. Our findings revealed MG132's potent anti-tumor activity with an IC50 of 1.258 ± 0.06 µM, significantly suppressing cellular migration at therapeutic concentrations. Apoptosis assays demonstrated concentration-dependent effects, with 2 µM treatment inducing early apoptosis in 46.5% and total apoptotic response in 85.5% of cells within 24 h. Mechanistic studies uncovered MG132's dual regulatory capacity: (1) Through MDM2 inhibition, it activated p53/p21/caspase-3 axis while suppressing CDK2/Bcl2, triggering cell cycle arrest and DNA damage cascades; (2) MAPK pathway activation emerged as a critical apoptosis driver. Notably, western blot analysis established dose-responsive modulation of these molecular targets, confirming pathway specificity. Our results position MG132 as a multi-target agent capable of simultaneously disrupting proliferative signaling and activating apoptotic machinery. The observed MAPK-mediated apoptosis mechanism provides novel insights for melanoma therapeutics, suggesting that combinatorial targeting of proteasomal and MAPK pathways may enhance treatment efficacy.

Trends in cutaneous malignant melanoma incidence, mortality and survival over three decades: a population-based study in Southern Spain

BACKGROUND

Cutaneous malignant melanoma (CMM) represents a global public health problem. Epidemiological studies about CMM trends tend to focus on single indicators or lack information about tumour characteristics that can help gain a more thorough understanding of CMM epidemiology.

OBJECTIVES

To fill this gap, we studied CMM trends in incidence, mortality and survival over three decades and that considered sex, age and tumour characteristics.

METHODS

Data were obtained for all patients with a new diagnosis of CMM during 1985-2017 from the population-based cancer registry in Granada (Southern Spain) and for deaths owing to CMM from the Ministry of Health of the Spanish government. Incidence, mortality and survival estimates were obtained according to sex, age group, anatomical site, histological type, Breslow index and Clark level. Observed and net survival were calculated for 1, 3 and 5 years using the Kaplan-Meier and Pohar-Perme methods, respectively. Log-linear jointpoint regression was used to assess temporal trends in age-standardized rates of incidence and mortality.

RESULTS

Between 1985 and 2017, 2446 patients aged ≥ 15 years were newly diagnosed with CMM. There was a significant increase in incidence, both in males and females (annual percentage of change 4.4% and 3.7%, respectively), mainly in superficial spreading and nodular melanomas, and more pronounced among those with < 1 mm Breslow index. Mortality rates increased, mainly driven by increases among males and individuals ≥ 65 years old. Nodular melanoma had the worst prognosis, with a 5-year net survival of 62.7% in the period 2008-2017 compared with survival > 90% for other subtypes. Overall 5-year net survival improved from 78.3% in 1985-1997 to 88.6% in 2008-2017, with a clear trend by Breslow index.

CONCLUSIONS

The incidence of melanoma in early stages in Southern Spain has increased over recent decades. This has been accompanied by noticeable improvements in mortality and survival, especially among younger age groups, suggesting the potential effectiveness of prevention strategies and new treatment regimens.

Nonfouling Core-Shell Microneedle for Sequential and Sustained Drug Release: Enhancing Synergistic Photothermal Chemotherapy in Melanoma Treatment

Melanoma is a highly aggressive and metastatic malignancy, where current treatment methods often result in damage to healthy tissues, suboptimal therapeutic outcomes, and immune-related side effects. Microneedles, as a drug delivery system, offer advantages such as localized administration, minimal invasiveness, and high delivery efficiency. In this study, we first synthesized tetradecyl-thiol-grafted PAMAM dendrimers, which significantly enhanced cellular uptake and enabled sustained release of doxorubicin (DOX), improving cumulative drug release efficiency. Based on this, we developed a core-shell structured zwitterionic polymer-based microneedle delivery system. The outer shell, loaded with the photothermal agent indocyanine green (ICG), achieved precise photothermal therapy under near-infrared irradiation, effectively targeting melanoma tissues. The inner core, composed of a zwitterionic polymer matrix, encapsulated DOX-loaded dendrimers, enabling controlled and prolonged drug release through gradual polymer swelling and dendrimer expansion. Experiments show that the microneedle drug delivery system based on PAMAM dendrimer grafted with tetradecyl mercaptan and zwitterionic polymer has excellent anti protein adsorption properties, and it can minimize the cytotoxicity of carrier and improve the efficiency of drug delivery. This system effectively inhibited tumor growth through synergistic photothermal-chemotherapy, reducing systemic toxicity and improving drug bioavailability. This microneedle platform provides a promising strategy for targeted and synergistic melanoma therapy, offering a high-efficiency and low-toxicity treatment alternative.

Exploring the association between dietary inflammatory index (DII) and different types of skin cancer: a cross-sectional study from NHANES 1999-2018

BACKGROUND

The potential role of diet-related inflammatory responses in skin carcinogenesis is gaining increasing recognition. This study investigated the association between the Dietary Inflammatory Index (DII) and different types of skin cancer in the United States general population.

METHODS

The study analyzed cross-sectional data on 45,409 participants in the 1999-2018 National Health and Nutrition Examination Survey (NHANES). The association between the DII and different types of skin cancer was estimated using weighted multivariable logistic regression, and its non-linearity was examined using restricted cubic spline (RCS) regression. Subgroup analyses were stratified by age, sex, race, body mass index, hypertension status, diabetes status, and frequency of skin-protecting behaviors.

RESULTS

The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for melanoma were 1.54 (1.02-2.35), 1.67 (1.02-2.73), and 1.55 (0.86-2.80) for the second, third, and fourth DII quartiles, respectively, compared with the first quartile. The adjusted ORs with 95% CIs for non-melanoma skin cancer (NMSC) were 0.90 (0.68-1.19), 0.96 (0.69-1.35), and 1.01 (0.70-1.45) for the second, third, and fourth DII quartiles, respectively, compared with the first quartile. The RCS curves showed no overall or non-linear significant association between DII and melanoma prevalence (P = 0.240, Pnon-linearity = 0.144) or NMSC (P = 0.068, Pnon-linearity = 0.410).

CONCLUSION

This study suggests that Compared with participants in DII quartile 1, those in DII quartiles 2 and 3 had a significantly increased risk of melanoma, whereas those in quartile 4 did not. These findings underscore the potential role of dietary inflammation in melanoma etiology and highlight the importance of further research to better understand and mitigate this risk factor.

Current Treatment Paradigms for Advanced Melanoma with Brain Metastases

The therapeutic management of melanoma brain metastases has undergone a profound revolution during recent decades. Optimal integration of systemic therapies with local treatments seems to represent the strategy to pursue in order to maximize clinical outcomes, stressing the need for real multidisciplinary care in this setting of patients. However, the current approach in the clinics does not necessarily reflect what the current guidelines state, and several pending issues are present, from the ideal therapeutic sequence between stereotactic radiosurgery (SRS) and drug administration to the current role of surgery and whole brain radiotherapy (WBRT), all of which need to be addressed. This narrative review aims to provide practical help for navigating the current controversies, with an eye towards possible future advancements in the field, which could help to obtain a comprehensive molecular characterization of the tumor and a more personalized patient-centered therapeutic approach.

Factors associated with the likelihood of being diagnosed with stage I melanoma in Germany: a multicenter study on 12 648 patients from the ADOReg skin cancer registry

BACKGROUND

The aim of the present study was to evaluate the factors associated with a higher or lower likelihood of being early diagnosed with melanoma at stage I in Germany.

METHODS

This retrospective cross-sectional study utilizes data from the German skin cancer registry (Arbeitsgemeinschaft Dermatologische Onkologie Registry) and included 12 648 patients with a first melanoma diagnosis in 80 hospitals between 1 January 2018 and 30 November 2024. Multivariable logistic regression analyses were conducted to assess the associations between demographic and clinical variables and the likelihood of being early diagnosed with stage I melanoma.

RESULTS

This study included 4138 patients with stage I and 8510 patients with stages II-IV melanoma. Factors including older age [adjusted odds ratio (aOR): 0.61] for age group 71-80 years and 0.54 for age group > 80 years, compared to the age group 18-40 year, male sex (aOR: 0.73), Celtic (aOR: 0.66), mixed (aOR: 0.58), and Mediterranean (aOR: 0.31) skin types, melanomas located on the gluteal region (aOR: 0.35), scalp and neck (aOR: 0.44), lower limb (aOR: 0.51), upper limb (aOR: 0.67), and back (aOR: 0.72) and being single (aOR: 0.81) were negatively associated with an early diagnosis of stage I melanoma. Finally, a positive association was observed between a family history of skin cancer and the likelihood of being diagnosed with stage I melanoma (aOR: 1.50).

CONCLUSION

This study provides important insights into the demographic and clinical factors associated with early-stage melanoma diagnosis in Germany and underscores the importance of targeted interventions aimed at increasing melanoma awareness.

Replicon RNA vaccines: design, delivery, and immunogenicity in infectious diseases and cancer

Replicon RNA (RepRNA) represents a cutting-edge technology in the field of vaccinology, fundamentally transforming vaccine design and development. This innovative approach facilitates the induction of robust immune responses against a range of infectious diseases and cancers. RepRNA vaccines leverage the inherent capabilities of RNA-dependent RNA polymerase associated with self-replicating repRNA, allowing for extreme replication within host cells. This process enhances antigen production and subsequently stimulates adaptive immunity. Additionally, the generation of double-stranded RNA during RNA replication can activate innate immune responses. Numerous studies have demonstrated that repRNA vaccines elicit potent humoral and cellular immune responses that are broader and more durable than those generated by conventional mRNA vaccines. These significant immune responses have been shown to provide protection in various models for infectious diseases and cancers. This article will explore the design and delivery of RepRNA vaccines, the mechanisms of immune activation, preclinical studies addressing infectious diseases and tumors, and related clinical trials that focus on safety and immunogenicity.

A new era in melanoma immunotherapy: focus on DCs metabolic reprogramming

Melanoma, being one of the most dangerous forms of skin cancer, is characterized by its aggressive and metastatic nature, with the potential to develop resistance to various treatments. This resistance makes the disease challenging to treat, emphasizing the need for new treatment strategies. Within the tumor microenvironment (TME), melanoma cells exploit metabolic shifts, particularly glycolysis, to create an immunosuppressive TME that prevents dendritic cells (DCs) from functioning properly. Essential metabolic alterations such as lactate and lipid accumulation, and lack of tryptophan disrupt DC maturation, antigen presentation, and T cell activation. In recent years, melanoma immunotherapy has increasingly focused on reprogramming the metabolism of DCs. This review paper aims to provide insights into the metabolic suppression of melanoma-associated DCs, allowing the design of therapeutic strategies based on metabolic interventions to promote or restore DC function. This contribution reviews the metabolic reprogramming of DCs as a new approach for melanoma immunotherapy.

Practice Patterns of Surveillance in Sentinel Lymph Node-Positive Malignant Melanoma​​​: An International Survey

OBJECTIVES

To understand surveillance practice patterns in melanoma patients with a positive sentinel lymph node (SLN) biopsy.

METHODS

A survey was designed, tested for item relevance, readability, and content validity, and subsequently distributed to melanoma surgeons through institutional emails and international societies.

RESULTS

Majority of the 59 respondents were <10 years from training (59.3%), in academia (74.1%), or dedicated >25% of their practice to melanoma (50.8%). Nearly all surgeons (98.3%) would not recommend complete lymph node dissection (CLND) for a 2 mm melanoma with nodal metastasis <1 mm. 79.7% of surgeons claim a significant role in determining the surveillance regimen, and most (57.6%) opt for a combination of nodal basin ultrasound and CT or PET/CT, while 39.0% follow with ultrasound only. No difference in surveillance modality was seen when stratifying time since training (≤10 vs. >10 y; P=0.798). However, for those who dedicate >25% of their practice to melanoma, significantly fewer surgeons report use of ultrasound only (>25%: 13.3% vs. ≤25%: 65.5%; P<0.001). Whereas 33.9% of surgeons state their surveillance strategy is agnostic to patient factors, others claim adherence to appointments (30.5%), distance from hospital (18.9%), and insurance (15.8%) shift their management. Breslow depth >4 mm (27.4%), ulceration (22.2%), and mapping to >1 basin (16.2%) are the most common reasons surgeons obtain cross-sectional imaging. Reasons that deter surgeons against ultrasound as the surveillance modality of choice include reproducibility/interpretation of the results (42.6%), patient preference (25.0%), and medical oncology preference (22.1%).

CONCLUSIONS

Despite trials aimed to inform the management of SLN-positive melanoma, surveillance strategies remain largely dependent on provider preference and individual patient factors.

Revealing tumor microenvironment communication through m6A single-cell analysis and elucidating immunotherapeutic potentials for cutaneous melanoma (CM)

BACKGROUND

The methylation of N6-methyladenosine (m6A) RNA plays a crucial role in the genetic regulation of various cancers. While m6A modifications have been extensively studied in the tumor microenvironment (TME) of several malignancies, their role in cutaneous melanoma (CM) remains unexplored.

METHODS

Using Non-negative matrix factorization (NMF) analysis on single-cell RNA-seq data (GSE215121) from three CM samples obtained from public databases, 26 m6A RNA methylation regulators were utilized to determine TME subclusters, their expression, and function.

RESULTS

Six distinct TME cell types were identified and NMF clustering further revealed unique m6A-based subpopulations of cancer-associated fibroblasts and T cells. The prognostic model demonstrated strong predictive capabilities, particularly for fibroblast and T cell m6A clusters, and highlighted COL3A1 as a critical regulator of melanoma-fibroblast interactions.

CONCLUSION

Highlighting the COL3A1 gene as a critical link and potential therapeutic target in melanoma could offer new avenues for targeted therapies and improve prognostic assessments in cutaneous melanoma.

The Impact of Dietary Intake of Furocoumarins and Furocoumarin-Rich Foods on the Risk of Cutaneous Melanoma: A Systematic Review

BACKGROUND/OBJECTIVES

Furocoumarins, chemical compounds found in many plant species, have a photosensitizing effect on the skin when applied topically and, by interacting with ultraviolet radiation (UVR), stimulate melanoma cells to proliferate. Whether dietary intake of furocoumarins acts as a melanoma risk factor has been investigated in several epidemiological studies, which are synthesized in our systematic review.

METHODS

The study protocol was registered with PROSPERO (registration number: CRD42023428596). We conducted an in-depth literature search in three databases coupled with forward and backward citation tracking and expert consultations to identify all epidemiological studies, irrespective of their design, addressing the association between a furocoumarin-containing diet and melanoma risk. We extracted information on the study details and results in a standardized manner and evaluated the risk of bias of the results using the Joanna Briggs Institute's critical appraisal tools.

RESULTS

We identified 20 publications based on 19 different studies providing information on the association between dietary furocoumarin intake and melanoma risk. We refrained from a meta-analytical synthesis of the results because of the large heterogeneity in exposure assessment, operationalization of furocoumarin intake in the analyses, and analytical methods of the studies. In a qualitative synthesis, we found moderate evidence supporting the notion that dietary furocoumarin intake at higher levels acts as a risk factor for cutaneous melanoma.

CONCLUSIONS

Our systematic review provides an overview of the current epidemiological evidence, but it could not clearly answer whether and to what extent dietary furocoumarin intake increases melanoma risk. Future epidemiological analyses focusing on this topic require more comprehensive dietary and UVR exposure data to better characterize the individual total furocoumarin intake and its interplay with UVR exposure patterns.

Cutaneous melanoma

Cutaneous melanoma is a common cancer in Australia and New Zealand, Europe, and North America, and its incidence is still increasing in many regions. Ultraviolet (UV) radiation exposure (for example, through excessive sunlight exposure) remains the primary risk factor for melanoma; however, public awareness campaigns have led to a marked reduction in mortality. In addition to genetic damage from UV radiation, specific genetic alterations have been linked to melanoma. The stage of the tumour at the time of diagnosis is of greater importance for melanoma prognosis than in almost any other cancer. Context-dependent genetic mutations that attenuate tumour-suppressive mechanisms or activate growth-promoting signalling pathways are crucial factors in the development of cutaneous melanoma. In addition to external factors such as UV radiation, the tumour microenvironment can contribute to melanoma progression, invasion and metastasis. Cutaneous melanoma treatment has improved considerably over the past decade with the discovery and development of immune checkpoint inhibitors and therapy targeting BRAF and MEK. Over the next decade, several priorities are likely to influence melanoma research and management, including the continued advance of precision medicine methods to identify the most suitable patients for the most effective treatment, with the aim of improving clinical outcomes.

Evolving Landscape of Melanoma in Portugal, Spain, Italy, and Greece: Trends and Insights

OBJECTIVE

To study melanoma incidence trends from 1990 to 2021 in Southern European countries-Portugal, Spain, Italy, Greece-and explore regional and age-period-cohort (A-P-C) patterns.

METHODS

Data from the Global Burden of Disease Study 2021 were used to calculate age-standardized incidence rates (ASIRs). Joinpoint regression and age-period cohort (A-P-C) models were applied to identify trends and patterns.

RESULTS

A substantial increase in melanoma ASIRs was observed across all Southern European countries from 1990 to 2021. Joinpoint analysis revealed a potential turning point in the 2010s, with ASIRs stabilizing or declining in younger age groups across all countries. For instance, rates among younger women in Italy, Portugal, and Spain have shown signs of stabilization or decline, while Greek women experienced a continued but slower increase. Men exhibited a similar trend, except for Greece, where the increase rate persisted albeit at a slower pace. Gender differences were evident, with younger women generally facing higher risks vs men but exhibiting a slower rise in incidence with age. The A-P-C analysis confirmed a pronounced cohort effect, indicating a higher risk for melanoma among earlier birth cohorts. Among younger generations, there is evidence of stabilization or even a decline in incidence rates.

CONCLUSION

Melanoma rates are rising in Southern Europe, especially among men. While younger populations show promising declines, likely due to sun protection efforts, older generations continue to be affected. Addressing regional disparities and sustaining these positive trends requires ongoing efforts and comprehensive prevention strategies.