**7. New approaches**

For years, the cornerstones of cancer treatment have been surgery, chemotherapy, and radiation therapy. Significant changes occurred in antitumor therapy for disseminated melanoma during the last decade. Detailed knowledge in the molecular biology of melanoma and immune response lead to the two directions: immunotherapy and targeted therapy. Before 2011, two approved drugs were used to treat patients with metastatic melanoma in the USA: dacarbazine and recombinant human interleukin-2 (IL-2) [24]. The treatment landscape for advanced stage melanoma was revolutionized in 2011 with the approval of ipilimumab and vemurafenib, both of which improved overall survival in phase III clinical trials. More recently, the targeted inhibitors dabrafenib and trametinib have demonstrated similar therapeutic profiles [25]. The latest approved (PD-1)-blocking antibody pembrolizumab is indicated for the treatment of patients with unresectable or metastatic melanoma [26].
