Sewa S. Legha, MD, FACP

The article by Bhatia and colleagues focuses on the treatment of patients with metastatic melanoma using standard therapies, but it also includes a brief outline of recent treatment approaches using investigational agents. In addition, the authors describe prognostic factors for metastatic melanoma, highlighting the impact of the extent of tumor and the site of metastasis (eg, soft-tissue vs visceral metastases) on survival.

Cutaneous malignant melanoma is a relatively common neoplasm. In the United States in 1995, an estimated 34,000 cases of melanoma will be diagnosed, and 7,200 persons will die of melanoma [1]. Early primary melanoma is highly curable, but once the disease becomes disseminated, it is nearly always fatal. The overall survival rate has more than doubled from 40% in the 1960s to more than 80% today, but this increase is attributable to earlier diagnosis rather than to treatment advances [2].

The treatment of advanced cutaneous melanoma remains disappointing. Single-agent cytotoxic drugs usually produce response rates of less than 20%, though newer agents, particularly fotemustine and temozolomide, show some promise, especially in patients with brain metastases.