For decades, no cancer therapy had been shown to improve average survival in metastatic melanoma. Two critical events have occurred, the discovery of melanoma driver mutation subsets and the discovery of immune checkpoint inhibitors, which have allowed for the development of modern, effective therapies. These findings have facilitated a rapid emergence of novel therapeutics for the disease with multiple FDA approvals in the last several years. The drugs vemurafenib, trametinib, and dabrafenib, which inhibit the commonly mutated BRAF pathway, have been approved based on improvements in survival outcomes. Agents that block immune checkpoints on lymphocytes allowing for immune cell activity against melanoma have also been approved based on improved survival outcomes such as ipilimumab and nivolumab. Pembrolizumab, another immune checkpoint inhibitor, has also been approved based on the response rate and duration of response in a phase 1 trial. Further agents and combinations of approved agents are positioned to possibly further increase this tally of approved drugs. This review will discuss recently approved novel agents and select drugs in development in advanced melanoma.

allergy. We contacted the Irish Medicines Board 2 (Dublin, Ireland), who had no reports of anaphylaxis in association with Roaccutane Ò and no information on underlying peanut allergy in reported allergic-type reactions to this medication. The Medicines and Healthcare Products Regulatory Agency 3 (London, U.K.) reported three cases of anaphylaxis in association with Roaccutane Ò . A history of peanut allergy may require the use of an alternative agent as in this case. We report the use of acitretin as an effective alternative to isotretinoin in the treatment of acne and also alert dermatologists to inform patients that Roaccutane Ò contains peanut extract. References1 Burke BM, Cunliffe WJ. The assessment of acne vulgaris-the Leeds technique. Br J Dermatol 1984; 111:83-92.