Better targeting melanoma: options beyond surgery and conventional chemotherapy

Skin cancer is the commonest malignant tumour in white skinned individuals in the western world. The incidence of skin cancer is on the rise. Case fatality for melanoma is probably the highest, not only among skin cancers but also among all types of cancers. The notion that cancer stem cells are responsible for disease progress and development has lead researchers towards these initiators of new metastases. Intra- and extracellular path inhibitors are targeted in eliminating crucial functions of tumor cells. Treatments are easily escaped from stem cells with pluripotent functional and proliferative potential. Immunomodulators are a useful treatment adjunct for highly immunogenic cancers such as malignant melanoma. Specific lineages of tumor cells are responsible for this modulation and targeting this cancer function with specific antibodies appears to be a reasonable but also effective treatment option. Chemoprotective agents have been proposed as a mean of reducing dose dependent toxicities and enlarging the therapeutic window of anticancer drugs. Current patent laws skew biomedical research to products that yield high profits rather than to global priority health needs in both developed and developing countries and with melanoma benefiting from this skew many new patents will continue to emerge. Most patents reported in this review follow the cytostatic rather than the cytotoxic paradigm. Based on this trend, one might anticipate that the goal for future advances in the treatment of melanoma patients would be to prolong their lifespan rather than cure them.