Adjuvant therapy for high-risk primary and resected metastatic melanoma.

Patients with thick, primary melanoma and regional lymph-node metastases are at moderate to high risk of recurrence and death, despite apparent complete surgical removal. Immune responses can be demonstrated against melanoma and this has prompted the conduct of a number of randomized trials of immunotherapy. Several trials have been completed and show minimal benefit in prolonging survival or recurrence from melanoma. Similarly, a large number of trials has been conducted to test the efficacy of alpha-2-interferon (IFN-alpha2) in therapy. Clear benefit in recurrence-free survival was shown in several trials, however there is a lack of convincing evidence of an effect on overall survival. Several trials of vaccine and IFN-alpha2 therapy are still in progress and their results are awaited with great interest. The use of high-dose IFN-alpha2 therapy remains a contentious subject, however available evidence suggests the standard of care remains good surgical management.