恶性黑色素瘤过去一直以手术切除和药物化疗为主要治疗手段，预后不佳。随着高通量基因测序技术的发展和对肿瘤分子机制认识的加深，人们发现肿瘤异质性和肿瘤微环境多样性影响了肿瘤的形成、耐药和治疗选择，导致了黑色素瘤患者对同种治疗方法的反应和获益不同。靶向治疗和免疫治疗的出现与进展，黑色素瘤患者的生存率显著上升，推动了黑色素瘤治疗的个体化与精准化，促使精准医疗成为研究的热点与趋势。本文旨在总结建立在精准分型和分子水平上的晚期黑色素瘤个体化综合治疗的研究进展，阐述精准医疗时代背景下黑色素瘤患者的生存现状，以及发展多种靶向治疗、免疫治疗或联合疗法的前景与必要性。

In the past, surgery and chemotherapy were the main treatment strategies for malignant melanoma, but companied with poor prognosis. With the development of high-throughput gene sequencing technology and the deepening understanding of tumor molecular mechanisms, it has been found that tumor heterogeneity and the diversity of tumor microenvironment affect tumor formation,drug resistance and treatment selection, leading to different responses and benefits of melanoma patients to the same treatment. The emerge and progression of targeted therapy and immunotherapy have significantly increased the survival rates of patients with metastatic melanoma, promoting the individualization and precision of melanoma treatment and making precise treatment a research hotspot as well as a trend. This review mainly summarizes the research progress of systemic individualized treatment of advanced melanoma based on precise subtyping and molecular level, and to get a more comprehensive view of the survival status of melanoma patients in the era of precision medicine, as well as the prospect and necessity of developing various targeted therapy, immunotherapy or combination therapy.

国家自然科学基金资助项目（No. 81972566）；北京大学临床医学+X青年专项基金资助项目（No. PKU2019LCXQ017）；北京白求恩公益基金会资助项目[No. BQE-TY-SSPC(1)-N-05]；北京医学奖励基金会资助项目（No. YXJL-2020-0889-0106）