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Even though most cases of malignant melanoma are diagnosed early and treated surgically, there are individuals whose condition will progress to more severe stages of the disease and require systemic treatment. Previously, if a patient failed surgical treatment, they could be treated with dacarbazine as the chemotherapeutic agent of choice. Recently, treatment options have expanded to include immunotherapy with high dose interleukin 2, ipilimumab and vemurafenib. The best treatment regimens are still being filtered out, but current recommendations are to individualise treatment based on several factors, such as skin type, extent of disease and location, which are used in determining the overall condition of the patient and severity of the disease.
Although widely used in the treatment of malignant melanoma, chemotherapy has not been shown to improve overall survival, leaving clinicians and patients looking for more effective and less toxic treatments. Interleukin 2 can provide long term disease free survival in a small number of people but can cause a severe toxic reaction in multiple organs, limiting its widespread use. Vemurafenib is another new agent on the market and has shown an increase in survival, but only in those patients whose tumour contains a V600 mutation in the BRAF gene. Those individuals …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.