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Generally, the synthesis of melanin is a complex process, with a multitude of genes influencing its production, such as tyrosinase-related protein 1 ( TRP-1 ), glycogen synthase kinase-3 beta ( GSK3 ), -catenin , cyclic adenosine monophosphate ( cAMP ), cAMP-response element binding protein ( CREB ), and solute carrier family 7 member 11 ( SLC7A11 ) [93, 185, 228]

They include: Endoscopic sclerotherapy : Injecting a solution to shrink the stomach pouch or stoma

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