1) The introduction of both anti-BRAF/anti-MEK targeted therapies and immune check-point inhibitors have greatly improved our potential to manage patients with advanced metastatic melanoma, with a significant impact on overall survival with respect to 10 years ago (median survival from 6 months up to more than 24 months)
2) It is known that specific parameters related to disease extension or site of involvment (high tumour burden, elevated LDH, brain metastases, ocular or mucosal primaries) represent relevant poor prognostic and predictive factors; in these patients, treatment options including combo-immune regimens or combination of immune therapies as well as triplets (anti-BRAF/anti-MEK plus anti-PD1, these latter still available only in clinical trials) should be considered.
3) The increase in overal survival deserves a crucial evaluation of quality of life which implies from a clinical point of view, a multidisciplinary management of these patients which takes into account the correct management of drug-related side effects, the psycological sphere, nutrition, fertility and pregnancy- related issues.
