Skip to main content

Advertisement

Log in

Recent Advances in Melanoma Staging and Therapy

  • Editorial
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Recent advances in the staging and treatment of melanoma were reviewed.

Methods: A literature-based review was performed.

Results: The current American Joint Committee on Cancer (AJCC) Staging system for melanoma has several drawbacks. Proposed changes in the staging system to take into account simplified tumor thickness categories, tumor ulceration, and the number (rather than size) of nodal metastases will allow stage groups with more uniform prognosis. The widespread application of sentinel lymph node biopsy for nodal staging allows accurate nodal staging with minimal morbidity. Reverse transcriptase-polymerase chain reaction (RT-PCR) is a very sensitive molecular staging test that may prove useful for identifying early metastatic disease. There is finally an effective adjuvant therapy for melanoma—interferon alfa-2b. Other adjuvant therapies, including melanoma vaccines, may provide effective and less toxic alternatives. New immunotherapy and gene therapy strategies are under investigation.

Conclusions: Ongoing and future adjuvant therapy trials will benefit from improved melanoma staging by accrual of homogeneous groups of patients. New approaches for adjuvant therapy await completion of clinical trials. Innovative new therapies offer hope for patients with advanced disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

REFERENCES

  1. Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of thecurrent American Joint Committee on Cancer Staging System for cutaneous melanoma and proposal of a new staging system. J Clin Oncol 1997;15:1039–1051.

    PubMed  CAS  Google Scholar 

  2. Veronesi U, Adamus J, Bandiera DC, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 1982;49:2420–2430.

    PubMed  CAS  Google Scholar 

  3. Sim FH, Taylor WF, Ivins JC, Pritchard DJ, Soule EH. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Cancer 1978;41:948–956.

    PubMed  CAS  Google Scholar 

  4. Balch CM, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996;224:255–266.

    PubMed  CAS  Google Scholar 

  5. Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet 1998;351:793–796.

    PubMed  CAS  Google Scholar 

  6. Balch CM, Ross M, Soong S-J, Harrison R. Long-term results of a prospective, randomized trial involving elective regional lymph node dissection in patients with intermediate thickness melanomas. Abstract 3. Presented at the 52nd Annual Cancer Symposium of the Society of Surgical Oncology, Orlando, FL, March 5, 1999.

  7. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–399.

    CAS  PubMed  Google Scholar 

  8. Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanoma of the head and neck. J Clin Oncol 1993;11:1751–1756.

    PubMed  CAS  Google Scholar 

  9. Ross MI, Reintgen D, Balch CM. Selective lymphadenectomy: Emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol 1993;9:219–223.

    CAS  PubMed  Google Scholar 

  10. Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases. Ann Surg 1994;220:759–767.

    CAS  PubMed  Google Scholar 

  11. Miliotes G, Albertini J, Berman C, et al. The tumor biology of melanoma nodal metastases. Am Surg 1996;62:81–88.

    PubMed  CAS  Google Scholar 

  12. Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol 1998;16:2253–2260.

    CAS  PubMed  Google Scholar 

  13. Albertini JJ, Cruse CW, Rapaport D, et al. Intraoperative radiolymphoscintigraphy improves sentinel lymph node identification for patients with melanoma. Ann Surg 1996;223:217–224.

    PubMed  CAS  Google Scholar 

  14. Glass LF, Messina JL, Cruse W, et al. The use of intraoperative radiolymphoscintigraphy for sentinel lymph node biopsy in patients with malignant melanoma. Dermatol Surg 1996;22:715–720.

    PubMed  CAS  Google Scholar 

  15. Kapteijn BAE, Nieweg OE, Liem I, et al. Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye. Ann Surg Oncol 1997;4:156–160.

    PubMed  CAS  Google Scholar 

  16. Van Der Veen H, Hoekstra OS, Paul MA, Cuesta MA, Meijer S. Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy. Br J Surg 1994;81:1769–1770.

    PubMed  Google Scholar 

  17. Ramnath EM, Kamath D, Brobeil A, et al. Lymphatic mapping for melanoma: Long term results of regional nodal sampling with radioguided surgery. Cancer Control: Journal of the Moffitt Cancer Center 1997;4:483–490.

    Google Scholar 

  18. Krag DN, Meijer SJ, Weaver DL, et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg 1995;130:654–658.

    PubMed  CAS  Google Scholar 

  19. Leong SPL, Steinmetz I, Habib FA, et al. Optimal selective sentinel lymph node dissection in primary melanoma. Arch Surg 1997;132:666–673.

    PubMed  CAS  Google Scholar 

  20. Mudun A, Murray DR, Herda SC, et al. Early stage melanoma: lymphoscintigraphy, reproducibility of sentinel node detection, and effectiveness of the intraoperative gamma probe. Radiology 1996;199:171–175.

    PubMed  CAS  Google Scholar 

  21. Balch CM, Cascinelli N, Sim FH, et al. Elective lymph node dissection: results of prospective randomized trials. In: Balch CM, Houghton AN, Sober AJ, Soong S-J, eds. Cutaneous Melanoma. St. Louis: Quality Medical Publishing, 1998:405–418.

    Google Scholar 

  22. Wang X, Heller R, VanVoorhis N, et al. Detection of submicroscopic lymph node metastases with polymerase chain reaction in patients with malignant melanoma. Ann Surg 1994;220:768–774.

    PubMed  CAS  Google Scholar 

  23. Shivers SC, Wang X, Li W, et al. Molecular staging of malignant melanoma: correlation with clinical outcome. JAMA 1998;280:1410–1415.

    PubMed  CAS  Google Scholar 

  24. Mellado B, Colomer D, Castel T, et al. Detection of circulating neoplastic cells by reverse-transcriptase polymerase chain reaction in malignant melanoma: association with clinical stage and prognosis. J Clin Oncol 1996;14:2091–2097.

    PubMed  CAS  Google Scholar 

  25. Morton DL, Eilber FR, Malmgren RA, Wood WC. Immunological factors which influence response to immunotherapy in malignant melanoma. Surgery 1970;68:158–164.

    CAS  PubMed  Google Scholar 

  26. Sondak VK, Wolfe JA. Adjuvant therapy of melanoma. Curr Opin Oncol 1997;9:189–204.

    Article  PubMed  CAS  Google Scholar 

  27. Sondak VK, Kopecky KJ, Smith JW II, et al. Is interferon-γ detrimental? Results of a Southwest Oncology Group randomized trial of adjuvant human interferon-γ versus observation in malignant melanoma. In: Salmon SE, ed. Adjuvant Therapy of Cancer VIII. Philadelphia: Lippincott-Raven, 1997:259–272.

    Google Scholar 

  28. Creagan ET, Dalton RJ, Ahmann DL, et al. Randomized, surgical adjuvant clinical trial of recombinant interferon alfa-2a in selected patients with malignant melanoma. J Clin Oncol 1995;13:2776–2783.

    PubMed  CAS  Google Scholar 

  29. Kirkwood JM, Strawderman MH, Ernstoff MS, Smith TJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group trial EST 1684. J Clin Oncol 1996;14:7–17.

    PubMed  CAS  Google Scholar 

  30. Kirkwood JM, Ibrahim J, Sondak V, et al. Role of high-dose IFN in high-risk melanoma: Preliminary results of the E1690/S9111/C9190 US Intergroup postoperative adjuvant trial of high and low-dose IFNα2b (HDI and LDI) in resected high-risk primary or regionally lymph node metastatic melanoma in relation to 10-year updated results of E1684. Abstract. Presented at the Advances in the Biology and Treatment of Cutaneous Melanoma Meeting, Boston, November 7, 1998.

  31. Belli F. Low dose interferon α2a as adjuvant treatment after radical node dissection for cutaneous melanoma. Update of WHO Melanoma Programme trial 16. Proc Soc Surg Oncol 1998;51:8.

    Google Scholar 

  32. Rusciani L, Petraglia S, Alotto M, Calvieri S, Vezzoni G. Postsurgical adjuvant therapy for melanoma: evaluation of a 3-year randomized trial with recombinant interferon-a after 3 and 5 years of follow-up. Cancer 1997;79:2354–2360.

    PubMed  CAS  Google Scholar 

  33. Pehamberger H, Soyer HP, Steiner A, et al. Adjuvant interferon alfa-2a treatment in resected primary stage II cutaneous melanoma. J Clin Oncol 1998;16:1425–1429.

    PubMed  CAS  Google Scholar 

  34. Grob JJ, Dreno B, Delaunay M, et al. Long-term results of adjuvant therapy with low dose interferon-a2a in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. Abstract. Proc Am Soc Clin Oncol 1998;17:514a.

    Google Scholar 

  35. Haluska FG. Adjuvant interferon for stage II melanoma. J Clin Oncol 1998;16:3205–3206.

    PubMed  CAS  Google Scholar 

  36. Buzaid AC, Bedikian A, Houghton AN. Systemic chemotherapy and biochemotherapy. In: Balch CM, Houghton AN, Sober AJ, Soong S-J, eds. Cutaneous Melanoma. St. Louis: Quality Medical Publishing, 1998:405–418.

    Google Scholar 

  37. Bleehen NM, Newlands ES, Lee SM, et al. Cancer Research Campaign phase II trial of temozolomide in metastatic melanoma. J Clin Oncol 1995;13:910–913.

    PubMed  CAS  Google Scholar 

  38. Rosenberg SA, Yang JC, White DE, Steinberg SM. Durability if complete responses with metastatic cancer treated with high-dose interleukin-2. Ann Surg 1998;228:307–319.

    Article  CAS  PubMed  Google Scholar 

  39. Keilholz U, Conradt C, Legha SW, et al. Results of interleukin-2-based treatment in advanced melanoma: A case record-based analysis of 631 patients. J Clin Oncol 1998;16:2921–2929.

    CAS  PubMed  Google Scholar 

  40. Lotze MT, Shurin M, Davis I, et al. Dendritic cell based therapy of cancer. Adv Exp Med Biol 1997;417:551–569.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McMasters, K.M., Sondak, V.K., Lotze, M.T. et al. Recent Advances in Melanoma Staging and Therapy. Ann Surg Oncol 6, 467–475 (1999). https://doi.org/10.1007/s10434-999-0467-8

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-999-0467-8

Key Words

Navigation