The melanoma field has seen an unprecedented set of clinical advances over the past decade. Therapeutic efficacy for advanced or metastatic melanoma went from being one of the most poorly responsive to one of the more responsive. Perhaps most strikingly, the advances that transformed management of the disease are based upon modern mechanism-based therapeutic strategies. The targeted approaches that primarily suppress the BRAF oncoprotein pathway have a high predictability of efficacy although less optimal depth or durability of response. Immunotherapy is primarily based on blockade of one or two immune checkpoints and has a lower predictability of response but higher fractions of durable remissions. This article reviews the clinical progress in management of advanced melanoma and also discusses the impact of the same therapies on earlier stage disease, where the agents have shown significant promise in treating resectable but high-risk clinical scenarios. Collectively, the progress in melanoma therapeutics has transformed the standard of care for patients, informed new approaches that are increasingly utilized for treatment of other malignancies, and suggest novel strategies to further boost efficacy for the many patients not yet receiving optimal benefit from these approaches.

在过去十年中，黑色素瘤领域取得了前所未有的临床进展。晚期或转移性黑色素瘤的治疗效果从反应最差的一种转变为反应性较好的一种。也许最引人注目的是，改变疾病管理的进步是基于基于现代机制的治疗策略。主要抑制 BRAF 癌蛋白通路的靶向方法具有较高的疗效可预测性，尽管响应的最佳深度或持久性较差。免疫疗法主要基于对一两个免疫检查点的阻断，反应的可预测性较低，但持久缓解的比例较高。本文回顾了晚期黑色素瘤管理的临床进展，并讨论了相同疗法对早期疾病的影响，这些药物在治疗可切除但高风险的临床情况方面显示出巨大的希望。总的来说，黑色素瘤治疗的进步改变了患者的护理标准，为越来越多地用于治疗其他恶性肿瘤的新方法提供了信息，并提出了新的策略，以进一步提高许多尚未从这些方法中获得最佳益处的患者的疗效。