Melanoma adjuvant therapy

The risk of recurrence and death after complete surgical resection of clinically detectable primary cutaneous melanoma ranges from low, intermediate to high risk depending on the stage of disease at diagnosis. This is defined by the depth, ulceration status and mitotic rate of the primary tumor, the presence of regional nodal disease or distant metastasis. For high-risk melanoma, adjuvant therapy aims at eradicating melanoma micrometastases in those patients that carry an unacceptable risk of mortality from melanoma recurrence. The ultimate goal of adjuvant therapy is to provide a potential cure before progression into advanced inoperable stages. After decades of randomized clinical trials, interferon-α alone has been shown to have a significant impact on relapse free survival and at high dosage on overall survival. These survival benefits were seen in comparison to observation (E1684 trial) and the ganglioside GMK vaccine (E1694 trial). Advances in our understanding of melanoma molecular biology and host immunology have given ways to novel targets and therapeutic agents that have demonstrated unprecedented results in the management of metastatic disease and currently are being tested in the adjuvant stetting where recent data support a significant clinical impact of adjuvant ipilimumab. Here, we review the standard of care melanoma adjuvant therapy along with the main completed, current and planned clinical trials.