Unlocking exosome potential: Comprehensive review on diagnostic, prognostic and therapeutic approaches in melanoma

Melanoma is one of the most lethal and aggressive forms of skin malignancies, which characterized by a high mutational burden, rapid metastatic dissemination and development of resistance to targeted and conventional therapies. Increasing interest in site-specific delivery has led to tailored therapeutic delivery mechanisms, resulting in enhanced pharmacodynamic success and diminished adverse effects. Currently, melanoma is marked by multifaceted mechanisms that interplay with drug resistance and enhanced metastatic propensity, providing a paradigm for exosome-mediated delivery. The advent of engineered exosomes poses an innovative delivery platform that transports diverse bioactive cargo such as DNA, lipids, proteins and mRNA, thereby modulating immune evasion, angiogenesis, pre-metastatic niche formation, tumor progression and therapeutic resistance. Beyond their biological functions, exosomes have emerged as potential minimally invasive biomarkers for melanoma prognosis, diagnosis and treatment monitoring owing to their biocompatibility, stability and capability to imitate the molecular profile of the primary tumor. The current developments in exosome engineering have marked their potential as natural nanocarriers in various therapeutic delivery approaches like chemotherapy, immunotherapy, radiotherapy and codelivery. The current review highlights the promising potential of exosome-based therapeutics as targeted therapeutics, prognostic and diagnostic biomarkers, and as a theranostic platform. Furthermore, the review critically analyzes current challenges associated with isolation and characterization of exosomes, safety, reproducibility, large-scale manufacturing and regulatory considerations of exosome-based therapeutics. Collectively, exosome-based strategies hold substantial potential for improving the diagnosis and management of melanoma, which may encourage the development of next-generation therapeutic interventions in the medical world.