The adjuvant treatment of malignant melanoma.

Interferon alfa-2b has recently been approved by the FDA as the first effective adjuvant therapy for the treatment of the "high risk for recurrence" melanoma patient. In a landmark study (ECOG 1684), the use of high dose Interferon alfa-2b for one year in melanoma patients with either deep primary melanomas or resected nodal metastases resulted in significant increases in overall survival (p = 0.04) and disease-free survival (p < 0.01) compared to the control, observation arm. If one considers only those patients with nodal metastases (89% of the study population) the survival benefit associated with adjuvant Interferon alfa-2b had a p value of 0.008. This survival benefit is on par with the survival benefit experienced with the adjuvant therapy of either breast or colon cancer. Because of the survival benefit associated with the adjuvant therapy, one could argue that any melanoma patient with a significant risk of nodal metastases (tumor thickness greater than 1.0 mm) should have a nodal staging procedure. Lymphatic mapping and sentinel node biopsy techniques are the least morbid and costly method to obtain this information. By performing nodal staging on patients with melanomas greater than 1.0 mm in thickness, effective adjuvant therapy can be applied in a selective fashion, exposing only those patients who have the most to benefit to the toxicities of the therapy.