The vast majority of early, thin (stage 1) melanomas are cured by the surgical excision described above. The prognosis for patients who have thicker tumors or who have relapsed is much more uncertain. The therapy of relapsed patients with melanoma remains a difficult task for the doctors as this tumour does not respond well to systemic therapy.
In patients who have not previously received chemotherapy, then the chemotherapeutic drugs mentioned above will be considered, sometimes together with immunotherapy agents such as interferon. Other times immunotherapy will be tried alone. The vaccine programmes are a developing area for patients who have failed standard therapy but are yet to be validated and all such patients will be in clinical trials. For individual problems, other therapies may be indicated. For example, brain radiotherapy may be useful for brain metastatic spread and for single brain metastases in otherwise better performance status patients then surgical resection or stereotactic radiosurgical (see brain tumour section) approaches may be used before or in lieu of whole brain radiotherapy.
Similarly, radiotherapy may be useful for painful bone metastases and in occasional other palliative settings.
