THE ACCURATE STAGING AND MODERN-DAY TREATMENT OF MALIGNANT-MELANOMA

The incidence of malignant melanoma is increasing faster than any othe r cancer in the United States and it is estimated that by the year 200 0, 1 in 75 people will get the disease sometime during their lifetime. Stimulated by novel lymphatic mapping techniques, the surgical care o f the melanoma patient is undergoing a change toward more conservative resections that will give equal staging information, without the adde d morbidity of more radical surgeries. This approach promises to yield positive results in the age of health care reform, outcome measuremen ts and cost: benefit considerations. In addition, molecular biology te chniques have been developed to more accurately identify, compared to routine histologic examination, those patients with occult metastases. With effective adjuvant therapies on the horizon, these assays become important to identify those patients who have had their primary and r egional disease resected but are at high risk for recurrence. A more s elective approach to adjuvant therapy will expose only those patients at a high risk for recurrence to the toxicities of the treatment, savi ng the majority of the patients at minimal risk the morbidity of the t herapies. The epidemic of malignant melanoma has caused many health ca re providers to rethink their efforts for this disease. Since ''thin'' melanomas are curable with simple surgical excision, a shift has occu rred in the public health arena to try to institute programs of preven tion and early detection rather than trying to cure Stage 4 disease. T his approach promises to have the most effect on the health of the Uni ted States, since it may take years before the results of the research being performed today in the basic science laboratories can be transl ated into curing patients with metastatic disease.