We review the current therapy for melanoma. The diagnosis, prognostic variables, staging, treatment, and follow-up guidelines for cutaneous melanoma are reviewed from the earliest to the most advanced stages. New guidelines for margins are discussed. A new, evolving, innovative radiographic technique, positron emission tomography using 2-fluorine-18-fluoro-2-deoxy-d-glucose, may be useful to identify subclinical nodal and visceral disease. Recent advances with respect to tumor vaccines, gene therapy, immunotherapy, and interleukin 2 as well as current concepts regarding lymph node dissection are discussed.

Current therapy for cutaneous melanoma.

Apart from its use in endocrinology and rheumatology, therapeutic nuclear medicine is developing rapidly as an additional treatment modality in oncology. Many different specific tumour-seeking radiopharmaceuticals are being applied both for diagnostic scintigraphy and treatment, using multiple routes and mechanisms to target radionuclides at tumours. After a brief introduction of some basic principles of radionuclide targeting, the therapeutic radiopharmaceuticals available are reviewed according to the accumulation site in relation to the cell nucleus; the results of their current clinical use for therapy are also reviewed. The response observed to a number of these applications, the non-invasiveness of the procedure and the relative lack of toxicity and late effects in comparison with chemotherapy and external beam radiotherapy make radionuclide therapy an attractive and realistic alternative in the management of malignant disease, as well as in the treatment of a few benign disorders.

Radionuclide therapy revisited.

Forty-nine patients were treated with either 3×75 MBq 89Sr or saline as placebo. Analysis of results 1 to 3 years after therapy revealed the ineffectiveness of 89Sr to relieve pain from metastases. Unexpectedly, a higher survival rate was found after Sr application (46% vs 4% after 2 years). Covariate analysis underlines the effect of 89Sr therapy on life expectation.

Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma.

To identify the regional lymph node basins cutaneous lymphoscintigraphy with technetium 99m rhenium sulfide colloid (/sup 99m/Tc-ReS) was performed in 45 patients and with technetium 99m antimony sulfide colloid (/sup 99m/Tc-Sb2S3) in seven patients after excisional biopsy of the primary tumor. All patients had skin tumors located in the face or neck or on the trunk with 47 cases of cutaneous malignant melanoma and 5 cases of benign or premalignant lesions. In 48 patients the scintiscans 1 hour after perilesional injection of the tracer colloid clearly showed the lymphatic drainage patterns from the tumor sites, of them 25 patients demonstrated unidirectional drainage, whereas the remaining 23 patients had multidirectional drainage to two or three lymph node groups. There were technical difficulties in performing the examinations in four patients. The authors recommend cutaneous lymphoscintigraphy as a safe, simple and reliable technique for mapping the lymphatic drainage preoperatively in patients with Stage I cutaneous malignant melanoma of axial localization.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819890101%2963%3A1%3C77%3A%3AAID-CNCR2820630113%3E3.0.CO%3B2-2

Preoperative cutaneous lymphoscintigraphy in malignant melanoma

Lymphoscintigraphy: radiopharmaceutical selection and methods.

An injection of 99mTc-labelled antimony sulphide colloid was used to show the lymphatic pathways in patients with malignant melanoma of the trunk skin. Using a gamma camera, optimal visualisation was obtained 15–30 min postinjection. Surprising deviations of the lymphatic pathways were found; therefore, this method makes it possible to plan continuity dissection appropriate to individual cases. Two examples are presented.

Scintigraphy of lymphatic vessels in malignant melanoma of the skin before operation (en bloc excision).

In 1970 and 1982, we reported on the results of Sr-89 treatment of pain caused by bone metastases in 81 patients with prostate carcinoma [1, 2]. Due to uncertainty inherent in the evaluation of this treatment within the manifold therapy of such patients, we decided, in agreement with the therapy commission of our Faculty of Medicine, to start a double-blind investigation in order to differentiate the Sr-89 effect from effects of simultaneously applied drugs (hormones, cytostatics etc.)

M. Schürer

Papers

Scintigraphy of lymphatic vessels in malignant melanoma of the skin before operation (en bloc excision).

On the Efficacy of Strontium-89 Therapy. Preliminary Evaluation of a Double-blind Study