Challenges in immunotherapy and targeted therapy era of advanced cutaneous melanoma: Toxicities, resistance, outcomes

In current intensive care units (ICUs), advanced cutaneous melanoma is no longer merely a terminal complication, but has evolved into a dynamic treatment-related syndrome. Immune checkpoint inhibitors can achieve durable disease control, but they may trigger fulminant multi-organ toxicity, requiring rapid identification and intervention to preserve anti-tumor benefits. BRAF/MEK targeted therapy enables rapid tumor debulking, but it easily induces severe events such as hyperprogression and tumor lysis syndrome due to drug resistance. Cellular therapies like tumor-infiltrating lymphocytes (TILs) offer new options for patients with previous treatment failure, but also bring ICU-related risks including cytokine release syndrome. This review proposes that ICUs should serve as upstream collaborators in melanoma care. It outlines key diagnostic and therapeutic pathways for various emergencies based on four core principles: toxicity recognition, standardized intervention, dynamic risk monitoring, and safe restart of systemic therapy. It also notes that future individualized management can be realized by integrating multi-dimensional indicators, to coordinate short-term organ support and long-term disease control, and improve the survival prognosis and quality of life of critically ill patients with melanoma.