[Adjuvant therapy of malignant melanoma]

The goal of adjuvant therapy after routine surgery of malignant melanoma is the effective suppression of progression of disease caused by clinically inapparent micrometastases. While individual small and mostly retrospective clinical studies comparing adjuvant chemotherapy with untreated historical controls suggested a possible benefit for treated patients, large and multicenter prospective, randomized studies failed to clearly demonstrate a benefit for treated patients in regard to improvement of disease free or overall survival. Therefore, adjuvant chemotherapy can no longer be recommended for patients with malignant melanoma outside of controlled clinical studies. Current promising candidates for successful adjuvant therapy of patients with malignant melanoma are recombinant biological response modifiers, in particular interferons. Three randomized studies consistently reported a benefit in regard to relapse free survival for patients treated with interferon-alpha compared to untreated controls. However, the impact, on extension of overall survival ('cure') remains unclear. Furthermore, to date, no definitive data on the optimal dose and duration of interferon-alpha-therapy are available. Thus, patients with high risk of tumor progression should be enrolled in national and international prospective, randomized clinical trials, which may lead to valid data and clear recommendations about optimal adjuvant therapy.