| Abstract: | Cutaneous melanoma is an enigmatic cancer with good survival rates with management at an early stage, i.e. thin superficial lesions localized to the primary site. However, once it becomes deeply invasive with evidence of metastasis, it is one of the most aggressive and lethal cancers. Many investigations have been done and are being conducted in the areas of prevention, (identification and removal of precursor lesions, sun avoidance and use of sun screen preparations), diagnosis (monoclonal antibodies, tumour markers) and therapy (immunotherapy, hyperthermic perfusion and randomized clinical trials. From the Royal Victoria Hospital, Montreal, Quebec, personal experiences with the use of a Levamisole/Placebo — double blind randomized clinical trial for Stage I Melanoma patients is presented. The results of another trial of combination chemoimmunotherapy utilizing BCG/DTIC and/or CCNU for Stage II patients is discussed. Experimental studies into the lymphocytic reaction of lymph nodes draining a primary melanoma site have been initiated and changes in the number of T cells and B cells in the lymph nodes have been noted, reflecting some systemic changes in the host. A prospective randomized surgical protocal on cutaneous melanoma of intermediate thickness (1 to 4 mm) is underway to determine whether a conservative local excision is sufficient and whether involved regional nodes are an indicator and not an instigator of further disease (Intergroup Melanoma Study). Hyperthermic limb perfusion as a therapeutic modality has still to be proven as a useful procedure in the management of melanoma. A clinical trial is urgently required. Increasing public and professional awareness coupled with pertinent clinical and basic research into various aspects of this disease make the future of the patient with melanoma not as black as it seems! |
