Systemic treatment of malignant melanoma: grade is as important as stage.

The prognosis of malignant melanoma relates to the biological profile of the tumour and is independent of the magnitude of surgery on the offending primary lesion. The optimal management of this cancer throughout its evolution depends on the appraisal of its metastatic potential. With better understanding of the natural history of the disease and improvements in the therapeutic ratio of currently available drugs, systemic treatment of high risk melanoma in the adjuvant context and before dissemination is emerging as a therapeutic priority. There is now evidence from recently published, controlled studies with long follow up that this approach can prolong relapse-free and overall survival.