Vivian Li, Kelly Frasier, Julia Vinagolu-Baur, Olivia Chapman, Alexandra Loperfito, Kathleen Daly, Viktoria Taranto
{"title":"Beyond the Scalpel: Advancing Strategic Approaches and Targeted Therapies in Nonexcisable Melanomas.","authors":"Vivian Li, Kelly Frasier, Julia Vinagolu-Baur, Olivia Chapman, Alexandra Loperfito, Kathleen Daly, Viktoria Taranto","doi":"10.1155/2024/2167176","DOIUrl":null,"url":null,"abstract":"<p><p>Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.</p>","PeriodicalId":17172,"journal":{"name":"Journal of Skin Cancer","volume":"2024 ","pages":"2167176"},"PeriodicalIF":1.2000,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11371453/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Skin Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2024/2167176","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.
面部、口腔表面和粘膜区等解剖位置的黑色素瘤给手术切除带来了独特的障碍。这篇综述结合这些复杂性研究了其他非手术治疗方式,探讨了现行指南中的不足之处以及现有疗法的不同疗效。我们使用 PubMed、Embase 和 Web of Science 数据库进行了全面的文献检索。综述主要针对同行评议文章,讨论复杂解剖位置黑色素瘤的非手术治疗方案。文章由三位独立研究人员进行筛选,确保对局部用药、免疫疗法、放射疗法和靶向疗法进行广泛分析。综述重点介绍了咪喹莫特和talimogene laherparepvec (T-VEC)髓内疗法等局部治疗方法的重大进展,这些疗法在治疗不可切除的黑色素瘤方面前景看好。BRAF和MEK抑制剂以及针对CTLA-4和PD-1/PD-L1通路的检查点抑制剂提高了生存率,但也带来了耐药性和全身副作用的挑战。由于黑色素瘤固有的抗放射特性,放疗成为一种辅助策略。尽管取得了一些进展,但在这些关键领域明显缺乏全面、循证的方案来指导黑色素瘤的治疗。本文强调了制定标准化治疗指南的必要性,这些指南应考虑到各种疗法的疗效、副作用和社会心理影响。未来的研究重点应放在完善现有治疗方法和探索创新模式上,以提高不可切除黑色素瘤患者的治疗效果。全面的指南和长期的疗效研究对于优化治疗和改善具有挑战性解剖位置的黑色素瘤患者的生活质量至关重要。
期刊介绍:
Journal of Skin Cancer is a peer-reviewed, Open Access journal that publishes clinical and translational research on the detection, diagnosis, prevention, and treatment of skin malignancies. The journal encourages the submission of original research articles, review articles, and clinical studies related to pathology, prognostic indicators and biomarkers, novel therapies, as well as drug sensitivity and resistance.