Melanoma: adjuvant therapy and other treatment options.

Melanoma, diagnosed and treated at its earliest stages, can be successfully cured by surgery alone. However, when metastatic beyond the regional nodes, it is almost uniformly deadly. Adjuvant therapy targeted toward the treatment of microscopic residual disease after surgical resection is the subject of intense scientific investigation because this is the stage at which it is possible to have the greatest impact on disease-free and overall survival. However, standard therapies commonly used for other solid tumors have had disappointing results in the treatment of melanoma in the adjuvant setting. These disappointing results have led researchers and clinicians to work to develop innovative treatment strategies for this disease, most of which center on the use of immunotherapy. The realm of cancer immunotherapy is broad and rapidly expanding; it encompasses strategies using immunomodulating agents, such as interferon and interleukin-2, in addition to a wide range of novel vaccination strategies for the induction of active antitumor immune responses. Although clinical trials continue to be conducted to sort out the safety and efficacy of a myriad of new treatment modalities and novel combinations of the old and the new, data indicate that high-dose interferon-alfa-2b should be offered to appropriately selected intermediate- and high-risk patients with melanoma not involved in an experimental protocol.