Yingzi Liang

Abstract Tumor clonal evolution and spatiotemporal heterogeneity are key drivers of therapeutic resistance in melanoma, often driven by selection pressures generated by systemic therapy. Genetic testing plays a key role in guiding targeted therapies, but a single biopsy may not fully reflect the mutational landscape. This paper reports a case of metastatic acral melanoma that demonstrated dynamic branching clonal evolution under systemic therapeutic stress.

3. Results 3.1. Evaluation Result Analysis of Urbanization and Road Traffic The upper limit, lower limit, median, and upper and lower quartiles of the evaluation results for each year are displayed in . The values outside the boundary are outliers, mainly cities with high scores. Looking into the boxes, the RTL in these 12 years is approximately clustered around 0.15, distributed from 0 to 0.4, and continues to grow from 2009 to 2020.