Regional and systemic strategies for metastatic malignant melanoma

Malignant melanoma is no longer a rare neoplasm. Recreational exposure to sunlight is undoubtedly an etiologic factor. Among all cancers, its rate of increase is exceeded only by that of bronchogenic carcinoma. Before administration of systemic therapy, histologic confirmation of the diagnosis and assessment of both the relative medical fitness of the patient and the available psychosocial support are important. Chemotherapeutic and interferon-alpha regimens may offer transient reprieve in 15 to 20% of patients but yield few long-term survivors. Other biologic response modifiers, such as tumor necrosis factor and interleukin 2, are promising but without established consistent efficacy. Postoperative systemic treatment programs for patients at risk for disseminated disease are of no proven benefit in randomized trials and cannot be endorsed outside of the context of a clinical trial. Radiation therapy may provide useful palliation, especially with a fraction of 400 cGy rather than the more traditional dose of 200 cGy/fraction. Selected patients with metastatic disease may benefit from surgical resection, but residual disease after attempted extirpation is usually associated with prolonged disability.