Over the last 2 decades, significant progress has been made in our understanding of the genomics, tumor immune microenvironment, and immunogenicity of malignant melanoma. Historically, the prognosis for metastatic melanoma was poor because of limited treatment options. However, after multiple landmark clinical trials displaying the efficacy of combined BRAF/MEK inhibition for BRAF-mutant melanoma and the application of immune checkpoint inhibitors targeting the programmed death-1, cytotoxic T-lymphocyte antigen-4, and lymphocyte activation gene-3 molecules, overall survival rates have dramatically improved. The role of immune checkpoint inhibition has since expanded to the neoadjuvant and adjuvant settings with multiple regimens in routine use. Personalized therapies, including tumor-infiltrating lymphocytes that are extracted from a patient’s melanoma and eventually reinfused into the patient, and messenger RNA vaccines used to target neoantigens unique to a patient’s tumor, show promise. Improvements in accompanying imaging modalities, particularly within the field of nuclear medicine, have allowed for more accurate staging of disease and assessment of treatment response. Continued growth in the role of nuclear medicine in the evaluation of melanoma, including the incorporation of artificial intelligence into image interpretation and use of radiolabeled tracers allowing for intricate imaging of the tumor immune microenvironment, is expected in the coming years.

在过去的 2 年里，我们对恶性黑色素瘤的基因组学、肿瘤免疫微环境和免疫原性的理解取得了重大进展。从历史上看，由于治疗选择有限，转移性黑色素瘤的预后很差。然而，在多项具有里程碑意义的临床试验显示 BRAF/MEK 联合抑制对 BRAF 突变黑色素瘤的疗效以及针对程序性死亡 1、细胞毒性 T 淋巴细胞抗原-4 和淋巴细胞活化基因 3 分子的免疫检查点抑制剂的应用之后，总生存率显着提高。此后，免疫检查点抑制的作用已扩展到常规使用多种方案的新辅助和辅助治疗。个性化疗法，包括从患者的黑色素瘤中提取并最终重新输注到患者体内的肿瘤浸润淋巴细胞，以及用于靶向患者肿瘤特有的新抗原的信使 RNA 疫苗，显示出前景。伴随影像学检查方式的改进，特别是在核医学领域内，可以更准确地对疾病进行分期和评估治疗反应。预计未来几年核医学在黑色素瘤评估中的作用将继续增长，包括将人工智能纳入图像解释和使用放射性标记示踪剂，从而对肿瘤免疫微环境进行复杂的成像。