Chemotherapy and immunotherapy for malignant melanoma

During the past decade there has been an enormous increase in the understanding of the natural history and the immunology of melanoma. Groups of patients who are at high risk of relapse are clearly defined. There has been multifold increase in knowledge about both humoral and cellular immunity in these patients. In spite of this knowledge, the enormous resistance of melanoma to any therapeutic modality has thwarted efforts at achieving an acceptable response rate. Although there are chemotherapeutic agents with a definite response rate, most notably DTIC, and although there are a number of new and exciting leads in this area, many patients who have relapsed or are destined to relapse are not significantly benefited by the administration of such agents. Immunotherapeutic modalities, particularly those administered locally or regionally, have had a modest impact on melanoma, but again it is doubtful that these have affected the natural history for many of these patients. The key to future progress in treatment of melanoma is accepting these facts by both patient and physician, and also, as a corollary, the appropriate therapy for patients with metastases or the risk of metastases is investigational.