LAUSR

#### What you need to know A 60 year old white woman who had a melanoma excised a year ago now presents with multiple subcutaneous nodules along her left shin. Biopsy confirms the lesions as metastatic melanoma, with molecular analysis revealing a BRAF wild type genotype. Imaging also shows several small nodules throughout her lungs. The patient is recommended to start systemic treatment with immunotherapy. About 132 000 cases of melanoma are diagnosed globally every year.12 Surgical excision is the first line treatment for localised disease.3 A minority of patients present with increased tumour growth or ulceration, or with metastasis (see box 1). The prognosis varies by stage at diagnosis. Data from the United States show five year survival rates of 98% for local disease confined to site of origin, 63% for regional metastases with spread to surrounding lymph nodes or tissues, and 17% for distant metastases.6 Systemic chemotherapy with drugs such as dacarbazine has shown limited benefits in patients with metastatic melanoma, with median survival between six and 10 months.789 Over the past decade, understanding of molecular biology and immune regulation in melanoma has led to advancements in the treatment of unresectable and metastatic melanoma. #### Box 1: Definitions of terms45