[Treatment of malignant melanoma: recent advances and perspectives]

Because malignant melanoma is a highly malignant neoplasm, correct diagnosis and appropriate treatment are essential to improve the prognosis. In the present paper the author summarizes the advancements in the therapy of malignant melanoma, reviewing papers recently published in this field. It is noteworthy that a narrow excision margin has been recommended even for the surgery of this neoplasm. This narrow margin has been approved by the prospective randomized trial performed by the WHO melanoma study group. The study group also confirmed that elective lymph node dissection is not significant in the improvement of the prognosis, when compared to the delayed lymph node dissection. Considering these findings, the author proposes a revised guideline for the treatment of malignant melanoma according to UICC stages. A brief comment is made on a new drug, fotemustine, that has an effect on brain metastases. In addition, high response rates obtained by the Dartmouth regimen (BCDT regimen), including tamoxifen, an estrogen antagonist, are reported. "Sequential" biochemoimmunotherapy based on a new concept of rational combination of chemotherapeutic and biologic agents seems highly effective against metastatic melanoma, showing more than 50% response rates. In the regimens, chemotherapy including CDDP is followed by administration of the cytokines, IL-2 and IFN-alpha. These regimens possibly induce specific and/or non-specific immune reactions against melanoma cells, which may contribute to the high response rates.