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-endorphin, the POMC-derived opioid peptide, has the capacity to upregulate melanogenesis and melanin distribution by promoting maturation of melanocytes and arborisation of their dendritic processes, thus increasing the efficacy of the transfer and distribution of melanosomes to neighbouring keratinocytes [23, 29]
RCT evidence: A: Robust replicated results from at least 2 large long-term double-blind RCT, ideally with confirmation from a systematic review or meta-analysis B: Supporting evidence from the primary outcome of at least one large long-term double-blind RCT C: A lack of supporting evidence from the primary outcome of a large long-term double-blind RCT but promising results from either small pilot RCTs or from post-hoc and planned secondary analyses
Individual biological variation plays a significant role in treatment response
Enucleation of the eye (ocular melanoma)
