JMIR Publications

ABSTRACT

Cutaneous melanoma has always been a dreaded diagnosis due to its high mortality rate and its proclivity for invasiveness and metastasis. Historically, advanced melanoma treatment was limited to chemotherapy and nonspecific immunotherapy agents that displayed poor curative potential and high toxicity. However, during the last decade, the evolving understanding of the mutational burden of melanoma and the immune system evasion mechanisms has led to the development of targeted therapy and specific immunotherapy agents that have transformed the landscape of advanced melanoma treatment. Despite the considerable strides in understanding the clinical implication of these agents, there is a scarcity in randomised clinical trials that directly compare the efficacy of the aforementioned agents, hence there are no clear-cut preferences among the available first-line options. Additionally, the introduction of these agents was associated with a variety of dermatological adverse event, some of which have shown a detrimental effect on the continuity of treatment. This holds especially true in the light of the current fragmentation of care provided by the managing health care professionals. This paper attempts to summarise the current understanding of first-line treatments. Additionally, it describes the indirect comparative evidence that aids in bridging the gap in the literature. Furthermore, this article sheds light on the impact of the scarcity of dermatology specialist input in the management of dermatological adverse events associated with advanced melanoma treatment. It also looks into the potential avenues where dermatological input can bridge the gap in the care provided by oncologists, hence standardising the care provided to melanoma patients with dermatological adverse events.