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Open trials in cutaneous malignant melanoma
1Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Abstract:
Surgery is still the primary treatment for cutaneous malignant melanoma. During the last 15 years randomized studies have given information on how to excise and we know now that thin melanomas (up to 2.0 mm in thickness) can be treated with 1-2 cm excision margins. Whether this is also true for thicker melanomas is not known and the only way to obtain more knowledge is to participate in prospective randomized studies. These have to be large due to the expected low difference in outcome or no difference in outcome between groups. The studies also involve adjuvant treatment of different types. No treatment in series, with large numbers and long follow-up, has shown improved overall survival compared with the control arm when different adjuvant therapies are given. Palliative treatment of disseminated melanoma has shown increasing response rates with combination chemotherapy and/or treatment with immune response modifiers but more data are needed. Clinicians with responsibility for patients with malignant melanoma and with an interest in improving outcome and quality of life should participate in ongoing clinical trials. Only with large prospective randomized trials of the design described in this article, will our knowledge increase for the benefit of our patients.
Insights
Participating in large clinical trials is crucial for advancing cutaneous malignant melanoma treatment. Ongoing research aims to determine optimal surgical margins and effective adjuvant therapies for all melanoma stages.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Cutaneous malignant melanoma management relies heavily on surgical intervention.
- Established guidelines recommend 1-2 cm excision margins for thin melanomas (≤2.0 mm).
- Optimal surgical margins for thicker melanomas remain undetermined.
Purpose of the Study:
- To investigate the efficacy of different excision margins for thicker melanomas.
- To evaluate the impact of various adjuvant therapies on overall survival.
- To encourage clinician participation in prospective randomized trials for melanoma research.
Main Methods:
- Analysis of data from large-scale, prospective, randomized clinical trials.
- Comparison of outcomes between different surgical margin groups.
- Evaluation of adjuvant treatment efficacy and palliative care strategies.
Main Results:
- No adjuvant therapy has demonstrated improved overall survival compared to control groups in large series.
- Palliative treatments, including combination chemotherapy and immune response modifiers, show increasing response rates in disseminated melanoma.
- Further data is required to confirm the benefits of these palliative approaches.
Conclusions:
- Large prospective randomized trials are essential for advancing knowledge in melanoma treatment.
- Evidence-based determination of optimal surgical margins and effective adjuvant therapies is needed.
- Clinician involvement in clinical trials is vital for improving patient outcomes and quality of life.