Abstract
Melanomas represent 4% of all malignant tumors of the skin, yet account for 80% of deaths from skin cancer.While in the early stages patients can be successfully treated with surgical resection, metastatic melanoma prognosis is dismal. Several oncogenes have been identified in melanoma as BRAF, NRAS, c-Kit, and GNA11 GNAQ, each capable of activating MAPK pathway that increases cell proliferation and promotes angiogenesis, although NRAS and c-Kit also activate PI3 kinase pathway, including being more commonly BRAF activated oncogene. The treatment of choice for localised primary cutaneous melanoma is surgery plus lymphadenectomy if regional lymph nodes are involved. The justification for treatment in addition to surgery is based on the poor prognosis for high risk melanomas with a relapse index of 50–80%. Patients included in the high risk group should be assessed for adjuvant treatment with high doses of Interferon-α2b, as it is the only treatment shown to significantly improve disease free and possibly global survival. In the future we will have to analyze all these therapeutic possibilities on specific targets, probably associated with chemotherapy and/or interferon in the adjuvant treatment, if we want to change the natural history of melanomas.
Highlights
Melanomas constitute 2-3% of all cancers, 95% presented as skin cancer and only 5% in nonskin locations
The results showed significant improvement in recurrence-free survival (RFS) and overall survival (OS) in group A versus C, but with no differences between B and C, meaning possibly that DTIC reverts the benefits of adjuvant IFN [23]
The first study, E1684, showed that patients who received adjuvant treatment presented a recurrence-free survival (RFS) at five years of 37% compared to 26% (P = 0.0023) in the untreated group
Summary
Melanomas constitute 2-3% of all cancers, 95% presented as skin cancer and only 5% in nonskin locations. Stage III patients are a very heterogeneous group, with high risk and worse prognosis as they always involve lymph node affectation where the number of affected nodes is an indicator of survival, with age, location, the presence of macro- or micrometastasis in the lymphatic nodes (67% versus 43% up to 5 years, P < 0.001), and so forth having an influence (Tables 2 and 3) [11, 12] In this stage and in the near future, other factors must be considered such as serum protein S100B levels, which are an independent prognostic factor as an initial baseline measurement, and during the followup,. On the other hand there is evidence to suggest that BRAF mutations pose a greater risk of recurrence and death [19]
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