Adjuvant therapy of malignant melanoma: is there a choice?

The methodological differences, data interpretation and conclusions of recent studies of adjuvant therapy in high-risk malignant melanoma, are discussed in detail in this communication. Two observations emerge from this analysis:There is as yet no adjuvant treatment that has conclusively been shown to influence overall survival for high-grade primary lesions with or without clinically occult microscopic metastases in regional lymph nodes. With currently available drugs, meaningful benefit is more likely, if adjuvant treatment is administered on development of clinically apparent regional lymph nodes metastases. The paradox of adjuvant therapy being apparently more effective in more advanced stages of the disease is not unique to melanoma and has been observed in other cancers. This paradox can be explained by the notion that currently available treatments will not eradicate the last malignant phenotype. They may, however, anticipate and frustrate the clinical expression of the next episode of disease activity, in a defined period of time.