黑素瘤是皮肤癌中最具侵袭性的形式，由于其高转移远处器官的倾向和发展对治疗的耐药性。由于治疗选择有限，黑素瘤的生物标志物指导治疗决策的需求显得尤为重要。在这种情况下，分析外周血液样本被认为是解决重复取样局限的一种有吸引力的替代方案，称为“液态活检”。特别是，由于它们在癌症扩散、免疫调节和耐药性方面的作用，外胞质囊泡（EVs）的分析已成为一种有前途的候选方法。随着我们对EVs在癌症和黑素瘤中的作用有更深入的了解，它们在临床使用方面的潜力越来越明显。在此，我们批判性地总结了目前支持EVs作为黑素瘤诊断、预后、治疗反应预测和耐药性生物标志物的证据。EVs被提议作为预测免疫检查点抑制治疗反应的候选生物标志物。然而，为了实现EV分析在临床决策中的潜力，强大的临床验证是必要的，强调了在这个领域需要进一步的研究的需求。 版权所有 © 2023 Elsevier Ltd.

Melanoma is the most aggressive form of skin cancer owing to its high propensity to metastasise in distant organs and develop resistance to treatment. The scarce treatment options available for melanoma underscore the need for biomarkers to guide treatment decisions. In this context, an attractive alternative to overcome the limitations of repeated tissue sampling is the analysis of peripheral blood samples, referred to as 'liquid biopsy'. In particular, the analysis of extracellular vesicles (EVs) has emerged as a promising candidate due to their role in orchestrating cancer dissemination, immune modulation, and drug resistance. As we gain insights into the role of EVs in cancer and melanoma their potential for clinical use is becoming apparent. Herein, we critically summarise the current evidence supporting EVs as biomarkers for melanoma diagnosis, prognostication, therapy response prediction, and drug resistance. EVs are proposed as a candidate biomarker for predicting therapeutic response to immune checkpoint inhibition. However, to realise the potential of EV analysis for clinical decision-making strong clinical validation is required, underscoring the need for further research in this area.Copyright © 2023 Elsevier Ltd. All rights reserved.