Malignant melanoma

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Abstract
Recent epidemiologic evidence showed an increase in incidence and mortality of malignant melanoma. Despite accounting for only 3% of all cutaneous malignant neoplasms, malignant melanoma causes 67% of deaths attributable to skin cancer. Sunlight plays a major role in the development of malignant melanomas. This is particularly bothersome in view of the projected decreases in the protective O3 layer of the atmosphere secondary to environmental indiscretions. Most melanomas originate in a radial growth phase characterized by peripheral growth and minimal or absent dermal invasion. This phase is associated with a low incidence of metastases and a good prognosis. The vertical growth phase is characterized by dermal invasion, high incidence of metastases and poor prognosis. Lentigo maligna and superficial spreading melanomas originate in a radial growth phase; nodular melanomas originate in a vertical growth phase. Surgery is the treatment of choice for primary melanoma. Disseminated melanoma treatment remains discouraging as evidenced by the poor survival of stage I and II patients. Dacarbazine remains the single most effective chemotherapeutic agent for disseminated tumors. Regional perfusion chemotherapy appears to be a promising tool in anatomically accessible lesions, but its effectiveness requires substantiation in carefully controlled studies. Radiotherapy remains palliative. Discouraging results were noted with combination chemotherapy. BCG is used in immunotherapy, but the most efficacious strains and mode of administration are unknown. Side effects, particularly tumor enhancement, limit the usefulness of immunotherapy, which remains an investigative modality requiring controlled clinical studies.