- Mucosal melanoma is an aggressive disease that is associated with worse outcomes compared with cutaneous melanoma. The inferior outcomes may be related to diagnosis at a more advanced disease stage, anatomic factors complicating complete resection, the rich lymphovascular supply of the mucosal surfaces, and the unique driver mutations prevalent in this cancer subtype.
- One of the most striking genetic features of mucosal melanoma is its relatively low mutational burden compared with cutaneous disease. Another distinctive feature is its high rate of copy number and structural variants.
- Effective locoregional control can be obtained through complete surgical resection. However, radiotherapy may be appropriate in the adjuvant setting, as wide negative margins may be difficult to achieve. In advanced mucosal melanoma, combination anti–PD-1 and anti–CTLA-4 treatment may be the preferred approach in those who are able to tolerate more aggressive therapies, given the higher response rates observed compared with single-agent checkpoint blockade. The potential for synergy between immunologic checkpoint blockade and radiotherapy is also being explored.