Medical management of stage IV malignant melanoma. Medical issues

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Abstract
Stage IV melanoma is defined by TNM staging as any tumor, any node, and M1, the presence of distant metastasis. The prognosis of Stage IV melanoma is grim. The expectation for 5-year survival is less than 10%. The experience with single-agent chemotherapy, combination chemotherapy, and high dose chemotherapy with autologous bone marrow transplantation support are reviewed, as are the results of treatment with interferon and interleukin-2. Chemotherapy with single agents yields up to a 20% response rate. More aggressive treatments with chemotherapy combinations yield approximately 40% responses but have no survival advantage over treatment with single agents. Recombinant alpha-interferon yields an objective response rate of approximately 20%. Results are dose related and require a dose in the range of 12 million U/M2 for optimal response. The results of treatment with interleukin-2 and lymphokine-activated killer cells are promising, but the optimal dose and method of administration need to be confirmed. The interesting appearance of a vitiligo-like depigmentation in some patients who respond to treatment seems to be associated favorably with survival. Gene transfer therapy opens up a new horizon for treatment of metastatic melanoma, and this exciting approach is discussed. The treatment of metastatic melanoma is reviewed, including the roles of surgery, radiation therapy, chemotherapy, interferon, interleukin-2, vaccines, and gene transfer therapy.