“…The developing resistance to targeted- or immuno-therapy leading to recurrent disease and death of the patient represents a significant challenge. There are different mechanisms underlying this negative phenomenon, including tumor heterogeneity with pre-existing mutations allowing clonal expansion of resistant cells, mutations during therapy and progression of the disease, mutator phenotype, metabolic heterogeneity, and dynamic changes in the tumor microenvironment, to name a few [ 4 , 6 , 25 , 30 , 37 , 74 , 75 , 87 , 130 , 165 , 178 , 179 , 182 , 211 , 218 , 229 , 230 , 231 , 232 , 233 ]. It must be noted that melanoma itself can affect the host response at local and systemic levels through production of neurohormonal regulators (as expected because of the neural crest origin of melanocytes) with immunosuppressive properties [ 3 , 50 , 82 , 234 ], including intermediates of melanogenesis and melanin that would increase resistance to any type of therapy [ 4 , 235 , 236 ].…”