Adjuvant Therapy in High Risk Patients with Primary Cutaneous Melanoma: Past, Present and Future

In spite of all the preventive measures, the incidence of melanoma of the skin continues to rise according to World Health Organization 2014. It is estimated that 132,000 patients are diagnosed globally each year. Therefore, cutaneous melanoma remains to be a worldwide health threat. Surgery remains to be the most effective therapeutic modality in the management of primary lesions. However patient survival depends on the stage of the disease at the time of diagnosis [1]. In general, superficial primary melanoma lesions, less than 0.75 mm depth of invasion and without other risk factors can potentially be cured by wide local excision only. On the other hand, high risk patients include those with deeply invasive primary lesions over 0.75 mm depth of invasion, as well as those with ulceration or high mitotic rate at the primary site even without palpable regional lymph nodes or distant metastases. They should undergo sentinel lymph node(s) identification and biopsy to rule out occult regional metastases.