Managing melanoma medically

Harrison Hot Springs, British Columbia - In reviewing the medical aspects of management of patients with high-risk or metastatic melanoma, the dermatologist should turn to the results of the American Joint Committee on Cancer (AJCC) melanoma staging committee.

The committee represents an international effort to establish a database of at least 18,000 patients who were carefully staged and followed for long-term survival, according to John A. Thompson, M.D.

"Analysis of this database allowed the investigators to identify clinical factors that predict patient relapse or survival," says Dr. Thompson, professor, University of Washington, medical oncology division, professor, Fred Hutchinson Cancer Research Center, and associate member, clinical research division. "The most important characteristics of primary melanoma were Breslow depth and the presence or absence of ulceration. Ulceration is defined histologically as the absence of an intact epidermis over the tumor."

Somewhat controversial

Ulceration is still viewed as somewhat controversial in the dermatology literature, a debate that led to Dr. Thompson's discussion of recent papers, which present conflicting viewpoints on the importance of ulceration,

Reviewing the AJCC's results led Dr. Thompson to the topic of treatments for resected, high-risk melanoma, including the use of interferon and experimental therapies, including vaccines. Medical therapies for melanoma may be seen as disappointing in the dermatologic community, yet the better understanding of the disease's cellular existence and proliferation aids clinicians now and instigates technological breakthroughs for the future.

"Interferon can lower an individual's risk of relapse and death, but at the cost of significant toxicity," Dr. Thompson tells Dermatology Times. "Therefore, it is important to carefully select a subset of patients who are candidates for interferon therapy, and to provide close medical support to ameliorate the toxicity of therapy."

Very challenging

The treatment of metastatic melanoma remains very challenging. Dr. Thompson reviewed U.S. Food and Drug Administration-approved treatments such as dacarbazine (DTIC) and interleukin-2, in addition to ongoing research to investigate other agents. These include temozolomide (Temodar, Schering) and sorafanib, and other agents.

"We have hope that different dosage amounts (of temozolomide) will make a difference in treating metastatic disease," Dr. Thompson says. "Further ongoing research also includes protocols designed to stimulate antigen specific T-cells, which target melanoma-specific antigens."

Future hope is also presented in a gene therapy protocol that is designed to alter the genetics of a patient's melanoma, rendering the tumor cells sensitive to valacyclovir.

More information regarding the AJCC's results can be found in the Journal of Clinical Oncology (19:3622-3634).