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Malignant melanoma: perspectives, diagnostics and treatment.

Life is one big road with lots of signs. So when you riding through the ruts, don’t complicate your mind. Flee from hate, mischief and jealousy. Don’t bury your thoughts, put your vision to reality. Wake Up and Live! —Bob Marley. Bob Marley died aged 36 years, from metastatic acral lentiginous melanoma, May 11, 1981. He was diagnosed in 1977 and refused surgery due to his Rastafarian religion. His last words to his son were “Money can’t buy life.” The first description of malignant melanoma was a secondary deposit described by John Hunter as a “cancerous fungous excrescence” in the 18th century, although this was not confirmed as melanoma until the specimen—still held at the Hunterian Museum at the Royal College of Surgeons of England in London—was examined histologically by Bodenham in 1968. The description of the disease of melanoma is debated and ascribed to either Dupuytren or more probably to Rene Laenne who first coined the term “melanosis” in 1812. Melanoma remains an elusive disease. Despite large epidemiology data sets upon which prognostic categories culminating in the AJCC staging criteria are based, patients with metastatic disease who should have a poor prognosis often survive for long periods. On the other hand, the thinnest of melanomas may be fatal due to metastasis, especially to the brain. Advances in techniques to treat brain metastasis have expanded the role of irradiation to more focused techniques such as gamma knife and similar highly focused strategies to good effect. Similarly, greater understanding of the molecular pathology of melanoma and the role of oncogenes such as nRAS, bRAF, and cKIT has started the ball rolling toward targeted chemotherapies. Similar strategies toward genes involved in tumor vascularization such as VEG-F also show some potential, although all these strategies are in their infancy. The roles of immune strategies such as vaccination and cytokine up-regulation again have not heralded the dramatic results anticipated, but progress continues to be made. In Balch et al’s edited textbook Cutaneous Melanoma, we have a nice summary of melanoma, including science and therapy within a clinical context. A more general dermatology text is also reviewed by Dr Lineaweaver. The 3rd UK Melanoma update, while disappointing in some respects, certainly provided a good overview as to the current state of melanoma therapy both in the UK and worldwide. Simple questions such as “do sunbeds cause melanoma” are not as simple to answer as one might think. Similarly, the tanning phenomenon has introduced new vocabulary into the English language, such as “Tanorexia.” We were told that the purported health benefits of UV irradiation such as synthesis of vitamin D are overstated, as very brief exposure to only the hands and face a few times per week are sufficient to maintain Vitamin D at normal levels. The most valuable take-home messages were as follows: