Preface

Melanoma is a severe type of skin cancer originating in cells called melanocytes. Despite being less prevalent than other skin tumors, melanoma is more deadly due to its tendency to migrate to other organs without rapid and early treatment.

This book presents the most relevant and up-to-date aspects of the epidemiology, diagnosis, biomarkers and treatment of melanoma, including specific sections on prognostic features and novel therapies, as well as particular clinical situations leading to a poor prognosis, such as brain metastases, or specific scenarios, such as uveal melanoma.

An accurate diagnosis is key and will determine both the prognosis and treatment landscape for each patient. The histopathological diagnosis of malignant melanoma remains the gold standard allowing the patient to access the entire diagnostic-therapeutic assistance process. Standard approaches are examined, as well as challenging situations which remain complex to diagnose. The various criteria used by dermatopathologists are also discussed.

As a systemic treatment, immunotherapy is part of the new therapeutic options that have significantly improved the prognosis of metastatic melanoma patients. The book reviews traditional immunotherapeutic approaches and focuses on immune checkpoint inhibitors such as anti-CTLA-4 inhibitors, anti-PD-1 inhibitors in monotherapy or in combination (dual immune blockade), presenting the key data that have achieved regulatory approval for current standard immunotherapies. Other systemic treatment options are also summarized, and a treatment algorithm based on American (NCCN) and European (ESMO) guidelines is provided, underlining the first, second and subsequent lines of treatment for both melanoma subtypes (BRAF wild type and mutated) and for particular cases, such as in-transit metastasis or brain metastasis. Special attention is given to treatment options for early and late disease progression (primary and acquired resistance after adjuvant therapy).

Beyond the standard approved treatments, recent advances in melanoma are also presented in this book. Systemic and local treatments undergoing clinical development, with their mechanisms of action, are included, together with preliminary or final results that have been presented, most of them in terms of response rate. Research has dramatically improved the prognosis in these patients, and we must

all continue working in this direction to help our patients and further improve their responses and survival.

Thanks are due to the authors for their valuable contribution and commitment to providing a clear and succinct overview of these topics.

> **Dr. Sonia Maciá** LAVA Therapeutics, Utrecht, The Netherlands

> > Section 1

Diagnosis and Clinical

Characteristics

**Dr. Eduardo Castañón**  Clínica Universidad de Navarra, Madrid, Spain

Section 1
