Chemotherapy for malignant melanoma: a brief review and personal experience

Chemotherapy for melanoma can be divided into four types: (i) intralesional chemotherapy; (ii) systemic chemotherapy to prevent the development of anticipated metastases; (iii) therapy for established disease; and (iv) combined with immunotherapy. Apart from a few general rules, it is difficult to predict the response to treatment. The smaller the bulk of tumour, the more likely is regression under treatment. Metastases in the skin, and to a lesser extent those in lymph nodes and lung, respond better than those in the liver and brain. Any response in established disease is likely to be temporary, although the patient tends to develop fatal disease at sites different from those involved when he or she was first treated. The best agent at present is imidazole carboxamide (D.T.I.C.), and its effect is not enhanced by combining it with other drugs. Combined prophylactic chemotherapy and immunotherapy is still under investigation, but the results are encouraging.