Current management and novel agents for malignant melanoma

Melanoma is a process when normal melanocytes undergo a malignant transformation [1]. Over the past year, there have been 3 agents approved for treatment of melanoma by Food and Drug Administration [2-4]. These include pegylated interferon alpha-2b for stage III melanoma [2], vemurafenib for unresectable or metastatic melanoma with BRAF V600E mutation [3], and ipilimumab for treatment of unresectable or metastatic melanoma [4]. The American Cancer Society estimates that 68,130 new melanomas was diagnosed and approximately 8,700 people died from melanoma in 2010 [5]. The incidence of Melanoma has increased to 22.52 per 100,000 in 2008 from 7.89 per 100,000 in 1975 [6]. Clinical and epidemiological data suggests increased incidence of melanoma in people with extensive or repeated exposure to sunlight [7]. Individuals with family history of melanoma are at significantly higher risk for developing this malignancy, representing 5-12% of all reported cases [8]. The risk of melanoma is associated with high nevi count [9]. One clinically dysplastic nevus is associated with 2 fold risk and 10 or more have a 12 fold increased risk of developing malignant melanoma [9]. Biopsy of a suspicious lesion is necessary for an accurate diagnosis and for optimal staging.Wide local excision is the treatment of choice for primary melanoma [10]. The proper resection margin is based on the thickness of the lesion. According to NCCN guidelines, melanoma with 1.0 mm or less (T1), wide excision with a 1.0 cm margin is recommended. For localized melanomas between 2 and 4 mm thick (T3), a 2 cm excision is suggested [10]. For thicker melanomas > 4 mm(T4), The U.S. Intergroup Melanoma Surgical Trial established that a 2-cm margin is adequate. Thick melanomas are associated with a higher risk of nodal and distant metastases. However, more extensive resection is unlikely to substantially change the outcome [1].Multicenter Selective Lymphadenectomy Trial evaluated the usefulness of sentinel-node biop