Mucosal melanoma: current strategies and future directions

Introduction: Mucosal melanomas are a rare subtype of melanoma that develop from melanocytes in the mucosal lining of the body, exhibit a distinct clinical behavior, and are associated with a worse prognosis. Due to this unique behavior and the rarity of the disease, optimal management strategies for mucosal melanoma remain uncertain. Areas covered: In this review, the epidemiology, genetic characteristics, treatment strategies, and recent developments in mucosal melanoma will be discussed. A literature search was conducted using the PubMed-NCBI database. The following searches were conducted: ?mucosal melanoma? ?mucosal melanoma? therapy; ?mucosal melanoma? diagnosis. Expert opinion: The treatment of mucosal melanoma remains challenging, with no established standard of care. For patients with localized disease who achieve a complete resection, there may be benefit with adjuvant chemotherapy, although the generalizability of this data remains in question. In patients with advanced disease, combination nivolumab and ipilimumab is a reasonable option in patients who are not eligible for a clinical trial. Ongoing trials assessing combinations of immune and targeted therapies offer promise and patients should be referred for enrollment in clinical trials whenever possible. Further studies are needed to identify biomarkers of response and resistance, understand the genetic landscape, and find the optimal sequence or combination of therapies.