[Chemohormonal therapy for malignant melanomas]

The management of malignant melanoma of the head and neck is controversial in view of the poor prognosis. Although radical surgery has been proposed as the best therapy for mucosal malignant melanoma, it has seldom been performed because of the extent of tumors and anatomical difficulties. In spite of testing various methods such as chemotherapy, radiotherapy and immunotherapy, that have been suggested for treatment of this malignant disease, there are still no well established effective therapies. We attempted chemohormonal therapy including TAM (Tamoxifen), an anti-estrogen agent, in six patients with primary malignant melanoma from 1993 to 1996. Three patients had a complete response, two had a partial response, and one showed no change. The toxicity in this protocol was found to be low. Generally, the patients showed good responses to chemohormonal therapy. TAM has been previously best known as a therapeutic agent for mammary cancer. Its anti-cancer effect is thought to be due to the anti-estrogen activity revealed by binding to the estrogen receptor competitively with estrogen in the tumor tissue. However, the mechanism of the action of TAM against malignant melanoma has not been clarified yet. Although its anti-cancer mechanism should be further explored, it is suggested that this chemohormonal therapy could occupy a very important position in the multidisciplinary therapy of malignant melanoma of the head and neck.