Novel insights into extracellular vesicles: An update on biomolecules, immunomodulation and clinical strategies in skin melanoma

Extracellular vesicles (EVs) have become key mediators of intercellular communication in melanoma cells and significantly affect disease progression by delivering bioactive molecules. EVs are loaded with a wide variety of biomolecule carriers, including proteins, DNA, mRNAs and non-coding RNAs, which can affect processes such as tumour growth, metastasis, angiogenesis, drug resistance and immune escape. Melanoma-derived EVs dynamically reshape the tumour microenvironment (TME) by regulating different cellular components, such as cancer-associated fibroblasts (CAFs), endothelial cells, T cells, macrophages and natural killer (NK) cells. In addition, we emphasize the enormous potential of EVs as minimally invasive biomarkers for diagnosis, prognosis prediction and treatment monitoring. The biocompatibility and targeting characteristics of EVs also make them promising platforms for drug delivery, including as carriers for chemotherapy drugs and immunomodulators. In this review, we emphasized the key role of EVs in melanoma and their dynamic regulation of microenvironment components, providing new diagnostic and therapeutic approaches for the use of EVs in the treatment of invasive malignant tumours. HIGHLIGHTS: Melanoma-derived EVs carry diverse biomolecules that reprogram the tumor microenvironment. EVs mediate immune escape, drug resistance and metastasis via key signaling pathways. EVs serve as minimally invasive liquid biopsy biomarkers for diagnosis, prognosis, and therapy monitoring. Engineered EVs offer promising platforms for targeted drug delivery and immunotherapy in melanoma.