Melanoma is often incorrectly perceived as a radiation-resistant tumor. Although curative therapy usually relies on surgical interventions, circumstances may arise where surgical intercession is not ideal, convenient, or even possible. In such situations, other modes of therapy such as topical immunomodulation, cryotherapy, or radiation therapy may provide alternatives, which in select cases may prove curative.

In this issue of The Melanoma Letter, Drs. Isaac Brownell, Nancy Lee, and Alice Ho at Memorial Sloan-Kettering Cancer Center explore the uses of superficial radiotherapy in treating certain types of melanoma. The technique can serve as an adjuvant therapy to regional lymph node basins in select patients at high risk for regional recurrence, as a palliative therapy for disseminated inoperable disease, and in select cases, as a primary therapy for lentigo maligna and lentigo maligna melanoma as well as unresectable in-transit metastases.  Dr. Reinhard Dummer also details the experience of European clinicians using superficial radiotherapy to treat LMM.

The quest for effective systemic therapy for metastatic melanoma has taken researchers down diverse paths ranging from cytotoxic chemotherapy, to immunotherapy, to ‘targeted’ therapy. Initial clinical studies utilizing many of these agents have frequently appeared quite promising, thus each has been embraced successively with enthusiasm. Unfortunately, despite improved disease-free survival in some patients, durable responses to most of these agents remain dismally rare.

Isaac Brownell, MD, PhD
Dermatology Service
Nancy Lee, MD, and
Alice Ho, MD, MBA
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York, NY

Cutaneous melanoma is a lethal malignancy that remains a therapeutic challenge despite an expanding number of advanced treatment options.¹ The only highly effective therapy is early detection and complete surgical excision of local disease. In patients presenting with more advanced melanoma, surgery can be combined with systemic therapies and/or radiation.²

Radiotherapy in the treatment of melanoma is likely underutilized owing to a historic misperception that all melanomas are radioresistant.³ More recent work suggests that melanomas show a range of sensitivity to radiation, and growing evidence supports use of this modality in select patients.^4,5

Immunotherapy has emerged as the most effective treatment for patients with metastatic melanoma. Much of the information concerning the immune response to melanoma has come from the study of tumor-infiltrating lymphocytes (TIL), immune cells that infiltrate into the stroma of the growing tumor and can be grown in vitro in the cytokine IL-2.¹ TIL have been used to identify dozens of antigens that are presented on melanomas.² Some antigens such as MART-1 and gp100 are shared by both melanomas and normal melanocytes, whereas others, such as NY-ESO-1, can be expressed on melanomas, but on no other adult tissue except the testes.