Abstract
Melanoma is a malignant tumour that arises from melanocytic cells. The incidence is increasing worldwide in white population where fair skin people receive excessive sun exposure. Although relatively uncommon in Africa-Americans, recent trends show increase incidence in Africa- Americans. Prognosis is affected by histological and clinical factors in addition to site of the lesion. It is a well-established facts that the MAPK signaling pathway is hyper activated in up to 90% of melanomas. The dependence of melanoma on this activated pathway has been exploited successfully in the clinics by selectively inhibiting this pathway mainly the BRAF mutated melanoma, which is mutated in approximately 50% of melanomas, although resistance develop in some cases. The improved understanding of the regulatory pathways of the immune system provides great hope for significant clinical impact in some patients. Antibodies inhibiting CTLA-4 and PD-1/PD-L1 signaling have been developed and approved, as monotherapies or in combination, after showing great improvement in patient survival but show limited efficacy in some patients that develop resistance and adverse effects. Better biomarkers are needed in the future to help select better immunothrapeutic agents with potent efficacy, less side effects and less likelihood to develop resistance.