[The latest diagnostical methods and therapy in melanoma]

Molecular biology, immunology, diagnostic and treatment of cutaneous melanoma have been analyzed on the basis of current literature due to the increasing frequency of this cancer. Due to the increasing frequency of melanoma it is crucial to detect early the malignant lesions on the basis of physical examination and noninvasive diagnostic methods (dermatoscopy, videodermatoscopy with total body photography). Histopathological examination is conclusive. In diagnostic imaging of early stage melanoma it is very important to evaluate the regional lymph node. In clinical practice, the cross-sectional imaging modalities including computed tomography (CT), ultrasound and magnetic resonance (MR) are widely used to assess lymph nodes. Sentinel lymph node (SLN) biopsy is currenly a valuable and reliable diagnostic procedure for precise staging of patients with clinically no cutaneous melanoma. The presence of SLN metastases is the most important negative factor for clinical outcome in melanoma patients. Introduction of RT-PCR allowed to detect individual cancer cells in tested sample of blood or tissue. Surgical treatment is an essential therapeutic modality in patients with melanoma. Treatment of a primary melanoma involves local excision of the tumour with a margin of skin and subcutaneous tissue. The role of systemic therapy is still a matter of clinical trials. Today's systemic therapy modalities include the use of biological agents (e.g. interferon alfa and interleukin 2) and cytotoxic agents. The efficacy of different types of melanoma vaccines (antigenic, cellular, DNA, GMTV) has been analyzed in numerous clinical trials. Results of these trials are still unsatisfactory. Dendritic cells in melanoma therapy will be very important in the future. Dendritic cells are the most efficient stimulators of T lymphocyte response among professional antygen presenting cells (APC) and the only APC capable to prime naive T lymphocytes with the antygen. A response to weakly immunogenic and tolerogenic tumor antigens can be achived with the use of DC as APC. This review represents an attempt to discuss current evidence on the place of adjuvant and palliative systemic therapy in melanoma.