Skin cancer is now the most commonly diagnosed cancer in the USA with about 5 million people treated every year. In Germany, the Federal Statistics Bureau reported last week that treatment for skin cancer in hospital has risen more than that for any other cancer. Some of this increase can be explained by better treatment options. For many years, there were only very limited choices to treat disseminated melanoma, in which median survival time was only about 6-9 months. In recent years, two distinct new therapeutic pathways have emerged with initially very hopeful survival benefits: immunomodulation with anti-CTLA4 monoclonal antibodies-eg, ipilirnumab^ and targeted treatment with BRAF inhibitors, such as dabrafenib. Initial excitement, however, has become more muted because immunomodulation can have long-term responses but only in very few patients, and the development of resistance to BRAF inhibitors means that overall the long-term prognosis of metastatic melanoma remains poor.
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