Advances in the treatment of cutaneous tumors: from conventional therapies to targeted and immunotherapeutic strategies

Cutaneous melanoma, one of the most common skin malignancies, has witnessed a continuously increasing incidence and is associated with a poor prognosis. In recent years, significant breakthroughs have been achieved in systemic therapies, particularly with the advent of targeted therapy (e.g., BRAF/MEK inhibitors) and immunotherapy (including anti-PD-1, anti-CTLA-4, and anti-LAG-3 agents, administered either as monotherapy or in combination). These advances have markedly improved survival outcomes for patients with advanced and metastatic melanoma. As these therapeutic strategies are extended to earlier stages of the disease, they are now widely employed in the adjuvant and neoadjuvant settings for patients with resectable stage II-III melanoma. In this context, the exploration of predictive and prognostic biomarkers—such as PD-L1 expression levels, tumor mutational burden (TMB), immune cell phenotypes, IFN-γ signature scores, and circulating tumor DNA (ctDNA)—has become increasingly urgent and intensive, aiming to precisely identify patients most likely to benefit and to optimize treatment decision-making. Furthermore, we discuss emerging technologies and future research directions aimed at optimizing clinical outcomes.This review aims to provide a comprehensive overview of the evolving landscape in the clinical management of cutaneous melanoma, with a particular focus on the paradigm shift from conventional therapeutic modalities towards innovative strategies such as targeted and immunological interventions. By systematically synthesizing existing literature and evidence from pivotal clinical trials, we seek to offer insightful perspectives for clinicians and researchers involved in the management of skin cancer.