Harnessing Melanoma Biomarkers: Revolutionizing Personalized Treatment Approaches

Melanoma care is confronting persistent uncertainties, and biomarkers are reshaping decisions in real time — with major guidelines endorsing routine BRAF testing while liquid‑biopsy applications are still evolving.

The role of melanoma biomarkers in personalized cancer treatment is evolving. Circulating tumor DNA (ctDNA) shows promise for monitoring disease burden and treatment response, whereas circulating melanoma cells (CMCs) remain largely investigational with limited routine clinical use. By addressing uncertainty in real time, liquid biopsy lays groundwork for newer molecular signals that may further refine decisions.

Recent studies are exploring how newer molecular signals could sharpen clinical precision. For example, miR‑567 expression has been linked to pathways associated with response and resistance in preclinical models, and melanocyte–Schwann cell phenotypic plasticity—a mechanistic concept still under investigation—may help explain cell‑state changes relevant to therapy. These mechanistic insights provide context but are not yet substitutes for validated, guideline‑backed tests.

Against that backdrop, established targets continue to anchor decisions at the bedside. For patients with actionable drivers, treatment choices mirror underlying biology. In BRAF‑mutant disease, combination BRAF/MEK inhibition improves progression‑free and overall survival versus monotherapy, though resistance commonly emerges, which in turn informs sequencing considerations with immunotherapy.

Implementing biomarkers in practice depends on workflow: multidisciplinary teams integrate tissue genotyping to confirm BRAF status for therapy selection today, while emerging tools like ctDNA are more often used in research settings or to support monitoring in select contexts. That implementation lens sets up the practical questions of resistance and sequencing addressed next.

Because resistance to targeted therapy is common, clinicians and patients increasingly plan for how to sequence systemic options. This includes considering when to prioritize immunotherapy versus targeted therapy and how to use interim monitoring signals to adjust follow‑up. These choices loop back to the central theme: biomarkers can reduce uncertainty, but their roles differ between monitoring and selection.

Looking forward, advances in liquid biopsy sensitivity, standardized reporting, and prospective trials will determine whether ctDNA or related assays move from promising adjuncts to routine practice. Those developments will also shape how exploratory signals like miR‑567 or cell‑state plasticity concepts are translated—or not—into clinical decision tools.