CD24 in Melanoma: Biomarker, Innate Immune Checkpoint and Emerging Therapeutic Target

Immune checkpoint inhibitors have transformed the treatment of advanced melanoma, yet many patients develop primary or acquired resistance. Although most work has focused on adaptive checkpoints (PD-1 and CTLA-4), accumulating evidence implicates innate immune suppression and stem-like, drug-resistant melanoma cell states. CD24, a small, heavily glycosylated glycosylphosphatidylinositol (GPI)-anchored surface protein, sits at the intersection of these processes and is emerging as a context-dependent biomarker and potential mediator of aggressive, therapy-resistant melanoma states. In this review, we synthesize evidence indicating that CD24 is both a tumour-intrinsic and tumour-extrinsic regulator in melanoma. We summarize the structure, glycosylation and regulation of CD24, then discuss its role in melanoma, supporting phenotypic plasticity, sustaining stem-like populations and promoting resistance to BRAF-targeted and cytotoxic therapies through SOX2/STAT3-linked programmes. We then examine the CD24-Siglec-10 axis as an innate immune checkpoint that suppresses macrophage and dendritic cell function, promotes immune-excluded 'cold' tumour microenvironments and may shape responses to immunotherapy among CD24+ melanoma cells. We highlight CD24 in tumour tissue, blood and extracellular vesicles as potential biomarkers of prognosis and pathway activity, and review CD24-axis interventions, including anti-CD24 antibodies, Siglec-10 antagonists and CD24-targeted CAR-T/CAR-NK cells, with rational combinations alongside PD-1/CTLA-4 blockade and MAPK-targeted therapy. We propose that biomarker-driven trials targeting this axis could open a new front in melanoma immunotherapy.