{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:45:53Z","timestamp":1791783953016,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100016947","name":"Swim Across America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016947","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pigment Cell Melanoma Res"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Mucosal melanoma is a rare, aggressive melanoma subtype arising from melanocytes within mucosal surfaces of the head and neck, anorectal, gastrointestinal, and genitourinary tracts. Unlike ultraviolet\u2010driven cutaneous melanoma, mucosal melanoma has lower tumor mutational burden, fewer BRAF V600 alterations, greater structural genomic complexity, and recurrent drivers including mutations in KIT, NRAS, NF1, SF3B1, and copy\u2010number alterations. It is often diagnosed at advanced stages, recurs locally, disseminates early, and responds less favorably to immune checkpoint inhibition than cutaneous melanoma. Low neoantigen burden contributes to this resistance, but emerging evidence indicates that antitumor immunity is also shaped by spatially organized tumor\u2010immune interactions, site\u2010specific mucosal biology, suppressive myeloid and stromal programs, angiogenic signaling, and underexplored innate checkpoint pathways. Here, we review mucosal melanoma as a biologically distinct model of immune\u2010excluded melanoma, summarizing its clinical behavior, genomic architecture, immunotherapy outcomes, and mechanisms of checkpoint resistance, with emphasis on restricted intratumoral CD8\u2010positive T\u2010cell infiltration, macrophage\u2010 and stroma\u2010rich barriers, angiogenic remodeling, and candidate innate checkpoints including B7\u2010H3, CD24\u2013Siglec\u201010, CD47\u2013SIRP\u03b1, and B7\u2010H6\/NKp30. We further discuss how spatial and circulating biomarkers may support response\u2010adapted translational studies and define actionable immune states across mucosal melanoma sites.<\/jats:p>","DOI":"10.1111\/pcmr.70127","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:08:37Z","timestamp":1791781717000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune\u2010Excluded Mucosal Melanoma: Spatial Mechanisms of Checkpoint Resistance and Biomarker\u2010Guided Therapeutic Opportunities"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8621-6538","authenticated-orcid":false,"given":"Kevin M.","family":"Truong\u2010Balderas","sequence":"first","affiliation":[{"name":"Department of Dermatology Rush University Medical Center  Chicago Illinois 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