Current treatment options for malignant melanoma

The incidence of malignant melanoma has increased at an alarming rate over the past few decades. Indications are that it will continue to rise in the foreseeable future. Primary prevention of malignant melanoma through education of the general public regarding the hazards of sun exposure is important in an attempt to reduce the incidence of the disease in the future. It can, however, be expected to take many years before a decrease in the number of cases of this disease is seen. Until such time, the medical oncologist will be faced with an increasing number of referrals for both adjuvant therapy and treatment of metastatic disease. Many agents have been investigated as possible postsurgical adjuvant therapies in patients with malignant melanoma. To date, interferon-alpha (IFN-alpha) given initially intravenously in high doses followed by subcutaneous therapy for 1 year, is the only treatment that has been shown to increase disease-free and overall survival in patients with high-risk melanomas. Patients falling into this group should still, wherever possible, be enrolled in prospectively randomised clinical trials. Although the prognosis for patients with metastatic melanoma remains poor, some progress in the management of this disease has been made. It has not yet been conclusively proven that combination chemotherapy yields superior results to single agent dacarbazine (DTIC) [which has for many years formed the cornerstone of therapy]. Immunotherapy involving IFNs and interleukin-2 (IL-2) alone or in combination has yielded similar results to those achieved with chemotherapy alone. The combination of chemotherapy plus immunotherapy appears to hold promise, with high response rates and often durable remissions reported, albeit at the expense of considerable treatment-related toxicity. Novel therapies including tumour vaccines and gene therapy also hold promise for the future management of this disease.