Cutaneous malignant melanoma: from early diagnosis to gene therapy.

Knowledge about diagnostic procedures in melanoma has increased rapidly within the past few years. These new techniques include epiluminescence microscopy and computerized image analysis of pigmented skin lesions, as well as the identification of single tumor cells in normal tissue, such as sentinal lymph node and peripheral blood by molecular approaches. The introduction of polymerase-chain reaction based methods can be regarded as a prototype of this dramatic development that opens up the possibility of clinical use in patients, and of influencing treatment strategies. While early melanoma is highly curable by surgical means, the prognosis of patients with metastatic disease remains poor. A flurry of new treatment strategies are currently in clinical development. These include test-directed chemotherapy, biologic therapy, vaccine therapy, as well as gene therapy. All different therapeutic strategies have to take into account immense resistance and escape mechanisms of malignant melanoma cells, that potentially limit the effectiveness of new treatment concepts.