Loading
The skin cancer that proved immunotherapy works: half of advanced patients now live 10 years. Also the first with an approved TIL therapy, an oncolytic virus, and a positive phase 3 personalised vaccine.
Melanoma arises from pigment cells; most cases are cured by excision when found early, and it is the skin cancer most likely to spread when it is not. Risk is driven by ultraviolet exposure and fair skin; the tumour carries the highest mutation burden of any common cancer, which is why it became the proving ground for immunotherapy. About half of cutaneous melanomas carry BRAF V600 mutations, a quarter NRAS, and acral and mucosal subtypes carry KIT alterations; uveal melanoma is a distinct disease driven by GNAQ/GNA11 and BAP1.
The treatment revolution began in 2011 with ipilimumab and vemurafenib and accelerated with PD-1 blockade (2014). Nivolumab-ipilimumab now delivers ~50% melanoma-specific survival at ten years in advanced disease (CheckMate 067), pembrolizumab 34% overall survival at ten years (KEYNOTE-006), and nivolumab-relatlimab offers a gentler doublet. For BRAF-mutant disease, DREAMseq settled that immunotherapy should come first. In resectable stage III disease, NADINA and SWOG S1801 moved immunotherapy to before surgery with response-adapted follow-on treatment, and adjuvant PD-1 or BRAF/MEK covers stage IIB-III. After immunotherapy fails, lifileucel TIL therapy (2024) and the oncolytic virus RP1 with nivolumab (2026) are approved; tebentafusp is the first survival-extending drug in metastatic uveal melanoma. Intismeran autogene plus pembrolizumab became the first personalised mRNA vaccine to pass a phase 3 in August 2026.
Open problems: roughly 40% of advanced patients never respond to immunotherapy, and second-line options after PD-1 failure remain limited; LAG-3 blockade failed as adjuvant therapy and with a different PD-1 partner; adjuvant treatment of stage II over-treats most patients; uveal, mucosal, and acral subtypes lag far behind; brain metastases affect up to half of advanced patients; and half the world's population lacks the HLA type required by the T-cell-receptor drugs.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Melanoma causes about 330,000 cases per year, and incidence is rising in fair-skinned populations.
Each skin cancer comes from a different cell layer: melanocytes and basal cells at the base of the epidermis, keratinocytes above them, Merkel cells and blood vessels in the dermis; depth of invasion decides the risk.
Same organ: Basal cell carcinoma, Cutaneous squamous cell carcinoma, Merkel cell carcinoma, Kaposi sarcoma, Skin cancer (all types), BRAF V600-mutant melanoma, Stage III melanoma (after surgery), Stage IIB and IIC melanoma, Advanced melanoma (unresectable stage III and stage IV), Mucosal melanoma, Acral melanoma, Advanced cutaneous squamous cell carcinoma, Locally advanced and metastatic basal cell carcinoma, Bowen's disease (squamous cell carcinoma in situ), Dermatofibrosarcoma protuberans
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsNivolumab-ipilimumab (about half of patients alive at ten years), BRAF/MEK inhibitors, lifileucel TIL therapy and RP1 after PD-1 failure; brain MRI at staging and radiosurgery for brain metastases.
Background: The blood-brain barrier & brain metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Uveal melanoma spreads almost exclusively to the liver.
One of the cancers most likely to reach the brain; brain MRI is part of stage IV staging.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Adjuvant pembrolizumab/nivolumab; neoadjuvant IO for resectable stage III.
Nivolumab-ipilimumab or nivolumab-relatlimab; BRAF/MEK if rapid control needed.
Lifileucel, RP1 + nivolumab, ipilimumab-based, trials; tebentafusp (uveal).
Dermoscopy, total-body photography for high-risk patients, excisional biopsy with Breslow thickness and ulceration reported; AI decision support emerging.
Wide local excision with margins by thickness (1-2 cm); sentinel lymph node biopsy from ~0.8 mm Breslow or with ulceration; nodal ultrasound surveillance rather than completion dissection if positive (MSLT-II).
Adjuvant pembrolizumab or nivolumab for one year (KEYNOTE-716, CheckMate 76K); discuss modest absolute benefit and irAE risk; ctDNA-guided trials.
Neoadjuvant ipilimumab + nivolumab (two cycles) then surgery with response-adapted adjuvant therapy (NADINA), or neoadjuvant pembrolizumab (SWOG S1801); alternative adjuvant-only PD-1 or, if BRAF-mutant, dabrafenib-trametinib.
Nivolumab or pembrolizumab for one year; dabrafenib-trametinib for BRAF V600 (COMBI-AD, 10-year RFS 48%); relatlimab adds nothing (RELATIVITY-098).
Nivolumab + ipilimumab (highest long-term survival; ~59% grade 3-4 events) or nivolumab + relatlimab (Opdualag; ~21%) or anti-PD-1 alone; for BRAF-mutant disease, immunotherapy first (DREAMseq) unless rapid control is needed.
BRAF + MEK doublet: encorafenib-binimetinib, dabrafenib-trametinib, or vemurafenib-cobimetinib; triplet with atezolizumab is approved but little used.
Lifileucel TIL therapy (accelerated approval 2024), RP1 oncolytic virus + nivolumab (2026), ipilimumab-based rechallenge, brenetafusp trials; clinical trials strongly encouraged.
Tebentafusp (OS benefit, IMCgp100-202); liver-directed therapy for hepatic-dominant disease; ipilimumab-nivolumab has modest activity.
Nivolumab + ipilimumab for asymptomatic disease (~50% intracranial response, CheckMate 204); stereotactic radiosurgery; BRAF/MEK for symptomatic BRAF-mutant disease.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.
Commercial and regulated products that are aimed at this cancer. Each card says what is behind it: a regulator's database, the literature, a public body's list, or only the company's own words. Listing is not endorsement, and a clearance is a regulatory fact, not a clinical one.
An electrical impedance spectroscopy device with a classifier that scores a suspicious skin lesion before the decision to excise.
A handheld spectroscopy device with an algorithm that tells a primary care clinician whether a skin lesion should be referred.
A smartphone application that assesses a photograph of a skin lesion and tells the user whether to see a doctor.