Melanoma of the skin is a common cancer only in Europeans, whereas it arises in internal body surfaces (mucosal sites) and on the hands and feet (acral sites) in people throughout the world. Here we report analysis of whole-genome sequences from cutaneous, acral and mucosal subtypes of melanoma. The heavily mutated landscape of coding and non-coding mutations in cutaneous melanoma resolved novel signatures of mutagenesis attributable to ultraviolet radiation. However, acral and mucosal melanomas were dominated by structural changes and mutation signatures of unknown aetiology, not previously identified in melanoma. The number of genes affected by recurrent mutations disrupting non-coding sequences was similar to that affected by recurrent mutations to coding sequences. Significantly mutated genes included BRAF, CDKN2A, NRAS and TP53 in cutaneous melanoma, BRAF, NRAS and NF1 in acral melanoma and SF3B1 in mucosal melanoma. Mutations affecting the TERT promoter were the most frequent of all; however, neither they nor ATRX mutations, which correlate with alternative telomere lengthening, were associated with greater telomere length. Most melanomas had potentially actionable mutations, most in components of the mitogen-activated protein kinase and phosphoinositol kinase pathways. The whole-genome mutation landscape of melanoma reveals diverse carcinogenic processes across its subtypes, some unrelated to sun exposure, and extends potential involvement of the non-coding genome in its pathogenesis. The first large, high-coverage whole-genome sequencing study of melanomas from cutaneous, acral and mucosal sites. Melanoma is a highly metastatic cancer with a high mutation load, and signatures in some subtypes are often associated with exposure to ultraviolet radiation. Graham Mann and colleagues report whole-genome sequencing of tumour samples from patients with melanoma, including 75 primary melanomas, 93 melanoma metastases and 15 cell lines derived from melanoma metastases. The authors compare the genomic landscapes of cutaneous, acral and mucosal subtypes of melanoma, identifying distinct mutational signatures by subtype. Cutaneous melanomas showed mutational signatures of ultraviolet radiation exposure, whereas acral and mucosal melanomas showed a lower mutation burden and more frequent complex structural rearrangements in comparison to other melanoma subtypes. Understanding the whole-genome landscapes of all melanoma subtypes is important for investigating melanoma prevention and targeted treatment.

Whole-genome landscapes of major melanoma subtypes