Adjuvant Therapy in Malignant Melanoma: A Trial of Immunotherapy, Chemotherapy, and Combined Treatment

Two hundred thirteen patients with malignant melanoma who underwent resection with curative intent were studied retrospectively at the Massachusetts General Hospital, and a group at high risk of recurrence was identified. The patients were classified by pathologic criteria utilizing Clark’s levels. All of the patients in this group had lesions of levels III, IV, or V with vertical thickness exceeding 1.5 mm [2, 3] and/or metastases to regional lymph nodes. This corresponds to stage II of the 1977 American Joint Commission For Cancer Staging and End Results Reporting. The observed recurrence rate in this group of patients was 25% at 1 year and 50% at 5 years. Many of these patients had distant metastases without evidence of local failure. This finding strongly suggests, though it does not prove, the presence of subclinical metastatic disease at the time of initial surgical treatment. The concept of clinically undetectable micrometastases with an important role for adjuvant treatment with chemotherapy is exemplified in the treatment of other solid tumors, notably carcinoma of the breast.