Epidemiology and clinical management of melanoma skin cancer: a systematic narrative

Abstract

Cutaneous melanoma is a highly aggressive skin tumor characterized by its heterogeneity, propensity for metastatic spread, and resistance to cytotoxic treatments. Although less common than other types of skin cancer, its high invasive capacity and mortality have drawn significant attention. The incidence of the disease has increased considerably, particularly in Western populations, due to ultraviolet radiation exposure and other risk factors such as advanced age, light skin phototype, and a history of dysplastic nevi. Advances in early diagnosis and the introduction of immunotherapies and targeted therapies have improved clinical outcomes, but challenges such as therapeutic resistance and the lack of reliable biomarkers still limit disease management. This study aims to synthesize knowledge on the epidemiology, diagnosis, and management of melanoma, contributing to the development of more effective and personalized clinical practices. This systematic review analyzed publications from the last two decades on cutaneous melanoma, focusing on epidemiology, clinical manifestations, and therapeutic strategies. Articles indexed in PubMed, LILACS, and Scielo databases using terms related to "cutaneous melanoma," "epidemiology," "immunotherapy," and "therapeutic strategies" were selected. Inclusion criteria encompassed studies on patients diagnosed with melanoma, from early to advanced stages, addressing risk factors, diagnosis, treatments, and clinical outcomes. Only articles published in Portuguese, English, and Spanish were accepted. Studies older than ten years, lacking consistent clinical data, or failing to differentiate melanoma subtypes were excluded. Data were analyzed to identify trends in clinical management and gaps in the literature, assessing the effectiveness of available therapies and emphasizing the importance of multidisciplinary approaches. A total of 100 articles were identified, 50 of which underwent full analysis. Only six studies were selected for the final review, aligned with the objectives of this work. The articles discussed advances such as the introduction of immune checkpoint inhibitors and targeted therapies, which improved survival in advanced cases. Emerging strategies, such as therapeutic nanoparticles, also showed potential for optimizing treatment. Immunotherapies, like PD-1 inhibitors, stood out for improving progression-free and overall survival, especially in metastatic cases. Targeted therapies, such as BRAF and MEK inhibitors, showed promising results in patients with specific mutations. Despite these advances, challenges such as toxicity, therapeutic resistance, and the need for more effective predictive biomarkers were highlighted. Furthermore, adjuvant strategies, such as the use of immunotherapies after surgical resection, demonstrated significant recurrence reduction, particularly in early high-risk stages. However, the application of emerging techniques, such as photodynamic therapy and therapeutic combinations, requires further research to validate their efficacy and safety. Therapeutic advances in managing cutaneous melanoma have transformed the disease into a potentially manageable condition, especially with the introduction of immunotherapies and targeted therapies. However, gaps remain, such as the need for safer therapies, strategies to overcome resistance, and more precise predictive biomarkers. Future research should explore new therapeutic combinations and emerging technologies to optimize diagnosis and personalize treatments. Additionally, expanding clinical trials and focusing on prevention and early diagnosis are essential to reduce the global impact of melanoma and improve clinical outcomes.