Approaches to the treatment of malignant melanoma in Europe

The European approach to the treatment of each stage of malignant melanoma can be characterized as cautious, avoiding unwarranted mutilation or toxicity as phase III trials have demonstrated that an aggressive approach in surgical management, adjuvant therapy and treatment of stage IV disease has met with very little success. Surgery: Phase III trials have demonstrated that wide margins, elective lymph node dissections and prophylactic isolated limb perfusions, bring no survival benefit. Primary melanoma is excised with a margin of 1 cm to maximally 2 cm and primary closure as a rule. Adjuvant Therapy in Stage II and III: There is no standard adjuvant therapy. High dose interferon treatment is practiced only sporadically in Europe as its high toxicity profile and an unclear long term impact on survival has met with very little popularity. Long term non-toxic lower dose IFN regimens and vaccines are currently being explored. Systemic Therapy in Stage IV: Phase III trials have shown that highly toxic polychemo-therapy or biochemotherapy has not produced a survival benefit over simple treatment with dacarbazide alone. In Europe biochemotherapy is being abandoned and various less or non-toxic approaches with vaccines and anti-angiogenic agents are currently under study.