Revisiting novel interventions in melanoma

Abstract

Malignant tumor which that arises from uncontrolled proliferation of melanocytes is melanoma. Its rare tumor in India, compared to other tropical countries. Fair skin populations have higher incidences of melanoma. The relative mortality is reduced to nearly half with scrupulous use of sunscreens - SPF 50 blocks 98% of UVB rays. Melanomas are observed more in countries like Australia and New Zealand (due to actinic rays (UV B rays) of light) and thus guidelines from their ministry of health has been published. First line drugs for melanoma unresectable stage III or IV metastatic disease include Pembrolizumab and Nivolumab. Studies have shown that Pembrolizumab improved overall survival (OS) compared with ipilimumab. Ipilimumab/Nivolumab combination was significantly better than ipilimumab monotherapy. Similarly nivolumab/ipilimumab combination therapy was better than compared with ipilimumab monotherapy regardless of BRAF mutation status. Vemurafenib and Dabrafenib (Tyrosine kinase inhibitors) were developed to inhibit BRAF with mutations at V600. Dabrafenib/Trametinib or Vemurafenib/Cobimetinib combinations were better than monotherapy. Surgery remains the best option for cure in localized, invasive melanoma, with good overall survival rate.