Abstract
Malignant melanoma has shown an increasing incidence during the last two decades, exhibiting a large spectrum of locations and clinicopathological characteristics. Although current histopathological, biochemical, immunohistochemical, and molecular methods provide a deep insight into its biological behaviour and outcome, melanoma is still an unpredictable disease, with poor outcome. This review of the literature is aimed at updating the knowledge regarding melanoma’s clinicopathological and molecular hallmarks, including its heterogeneity and plasticity, involving cancer stem cells population. A special focus is given on the interplay between different cellular components and their secretion products in melanoma, considering its contribution to tumour progression, invasion, metastasis, recurrences, and resistance to classical therapy. Furthermore, the influences of the specific tumour microenvironment or “inflammasome”, its association with adipose tissue products, including the release of “extracellular vesicles”, and distinct microbiota are currently studied, considering their influences on diagnosis and prognosis. An insight into melanoma’s particular features may reveal new molecular pathways which may be exploited in order to develop innovative therapeutic approaches or tailored therapy.
Highlights
Located in the basal layer of the epidermis and dermis of the skin, by their ability of melanin synthesis, melanocytes cooperate with neighbouring cells, especially keratinocytes, to protect DNA from ultraviolet light (UV)-induced damage
According to the results reported by Pandey et al, a rapid progression of tumour cells is associated with high fatty acid synthase (FASN) activity, an increased expression of caveolin-1 (Cav-1), and stimulation of phospho-Akt, a protein kinase that plays a critical role in survival and apoptosis regulation [243]
Malignant melanoma exhibits a large spectrum of locations and clinicopathological characteristics, and its features are important in practical activity for diagnosis, differentials, and therapy
Summary
Located in the basal layer of the epidermis and dermis of the skin, by their ability of melanin synthesis, melanocytes cooperate with neighbouring cells, especially keratinocytes, to protect DNA from ultraviolet light (UV)-induced damage. Melanoma biomarkers may be classified into different categories, such as diagnostic (showing a higher expression in melanoma cells than in normal tissue), prognostic or predictive markers (showing an increased expression in advanced stages of disease and providing valuable information regarding the treatment response or, on the contrary, correlated to disease recurrence), and progenitor and/or stem cell markers (specific for cell subpopulations that exhibit high carcinogenicity, metastatic potential, and treatment resistance) [5,6,11,13–16]. Melanoma’s “tumour niche” consists of an ensemble of malignant cells associated with other cells, such as keratinocytes, cancer stem cells, cancer-associated fibroblasts, endothelial cells, and immune cells This microenvironment has an impact on melanoma cell progression and resistance to therapy [19]. Aggressive melanoma behaviour may be attributed to its heterogeneity, including a population of cancer stem cells (CSCs) [20], currently studied in order to identify their specific markers, which may be further exploited considering their prognostic and therapeutic potential [20]. Overcoming controversies related to the value of some tumour markers, this review of the literature is aimed to update the knowledge regarding the specific clinicopathological, genetic, and molecular hallmarks, along with providing a comprehensive guide of the tumour microenvironment’s involvement in melanoma prognosis and management
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