**4. Discussion**

Cancer is a major cause of morbidity and mortality in our society. It shows a huge price and has many devastating effects. Melanoma is a tragic example of these realities.

The prognosis of melanoma is closely linked to early diagnosis. Current treatments have limited effectiveness, and surgery remains the mainstay of treatment. Better treatments are certainly necessary, even with the arrival of molecules such as ipilimumab or vemurafenib that enable new perspectives for our patients with metastatic disease.

In the past, the only prognostic factor in melanoma patients has been limited to histology (tumor thickness) and the location of the primary tumor. These parameters are important, but were supplemented by numerous clinical variables, pathological and biological, particularly in patients with advanced melanoma. Recently, the use of serum markers, alone or in combi‐ nation, has been proposed to refine the prognosis of a patient in order to ensure proper tracking and predicting the potential benefits of therapy. More specific or nonspecific markers of melanoma can be measured in the serum of patients, and in most cases, these markers are directly correlated with the tumor mass.

Among these biomarkers, LDH and S100B serum biomarkers appear with an independ‐ ent prognostic value, although disputed by some. In advanced melanoma, their dosage is probably more accurate and sensitive than CRP levels (LDH and CRP are obviously more accessible and measured) as shown by some studies, but not ideal. Even if the LDH is incorporated into the new AJCC classification, for some authors, S100B is superior in terms of prognostic value [31].

To a lesser extent due to poor sensitivity or lower specificity, CRP, MIA, and Gal-3 can also be considered as interesting biomarkers. The dosages of new other molecules should be included in future prospective clinical protocols, distinguishing their prognostic value (patient out‐ come) and predictive value (response to treatment).

Storage conditions of serum should also be made clear in all the articles as they have a major influence on results and therefore conclusions. This suggests that a standard methodology should be set in order to compare the published studies [32].

Research into new biomarkers in melanoma is important issue because i twill lead to better understand the biology of this tumor, and thus it improve patient monitoring, early detection and treatment of secondary lesions and open new perspectives for targeted therapies. Multiple molecular changes of melanoma progression are currently intensively studied.
