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Annals of Surgical Oncology, Vol 6, Issue 5 467-475, Copyright © 1999 by Society of Surgical Oncology
ARTICLES |
K. M. McMasters, V. K. Sondak, M. T. Lotze and M. I. Ross
Department of Surgery, University of Louisville, KY, USA.
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.
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