Answer
Since 2011, multiple novel systemic therapies for metastatic melanoma (stage IV) have become available. These include immune checkpoint inhibitors and targeted therapy, which have led to durable responses and some improvement in overall survival and quality of life.
Several FDA-approved immunotherapy options are currently available for melanoma. These include the immunomodulator checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab; the cytokines interferon alpha-2b and peginterferon alpha-2b; and oncolytic virus therapy with T-VEC.
Currently, FDA-approved targeted therapies for melanoma includes the oral BRAF inhibitors dabrafenib (Tafinlar) and vemurafenib (Zelboraf) for melanomas with a mutated or activated BRAF gene and the oral MEK inhibitor trametinib for patients who have melanoma with a BRAF V600E or V600K mutation. BRAF and MEK inhibitors are usually given in combination. Other targeted therapies in clinical trials include KIT inhibitors. Tumor-infiltrating lymphocyte (TIL) immunotherapy is also under investigation for the treatment of metastatic melanoma. [9, 10] This is an area of intense medical research, with ever-increasing degrees of biological sophistication being applied to new clinical trials.
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Color photograph of a dome-shaped choroidal melanoma.
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Early fluorescein angiogram of choroidal melanoma showing intrinsic vascularity.
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Late fluorescein angiogram of choroidal melanoma showing early diffuse staining.
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B-scan ultrasound showing acoustic hollowing and uveal excavation in posterior choroidal melanoma.
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A-scan ultrasound of choroidal melanoma showing low-to-medium internal reflectivity.
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B-scan ultrasound showing acoustic hollowing in intraorbital extension of a posterior choroidal melanoma.
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T2-weighted MRI showing a small anterior choroidal melanoma in the left eye.
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Transpupillary photograph showing a posterior choroidal melanoma.
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Photograph showing an enucleated eye with advanced choroidal melanoma with transscleral extension.
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Histologic section of an enucleated eye showing a large dome-shaped choroidal melanoma.
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Histologic section of an enucleated eye showing a medium-sized mushroom-shaped choroidal melanoma with associated exudative retinal detachment.
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Choroidal melanoma. Histologic section showing spindle A cells in a uveal nevus.
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Choroidal melanoma. Histologic section showing spindle B cells in a uveal melanoma.
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Choroidal melanoma. Histologic section showing epithelioid cells in a uveal melanoma.
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Photograph showing a skin metastasis of a posterior choroidal melanoma.
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Intraoperative photograph showing placement of a radioactive plaque for posterior choroidal melanoma.
