Melanoma recurrence

Interferons. Interferon alfa is used for chronic granulocytic leukaemia, hairy cell leukaemia, renal-cell carcinoma and Kaposi s sarcoma. It may also be an effective aduvant therapy for patients at high risk of melanoma recurrence. 

Richard, Nashville, Tennessee. Melanoma recurrence, stage 3, diagnosed in 2006 at age sixty-four. (Treatment surgery. Chemo cisplatin, vinblastine, dacarbazine and interferon.)... 

Lazarus M, Kaufman H. An association between corticosteroid use and melanoma recurrence a case report and review of the literature. Med Oncol 2012 29(3) 2018-20. 

Stage IIB, IIC, and III melanoma are considered to be high risk because of their potential for recurrence and distant metastasis. The primary treatment modality is surgical excision of the tumor and a lymphadenectomy for patients with positive lymph nodes. 

Proleukin is a recombinant form of IL-2. It is approved for the treatment of malignant melanoma and renal cell cancer. Ontak (denileukin diftitox) is a fusion protein for the treatment of persistent or recurrent T-cell lymphoma. Activated T cells express lL-2 receptors. Ontak has a fragment that binds to the IL-2 receptor while the other part presents a diphtheria toxin to kill the activated T cell. 

Megestrol acetate has also proved of value in patients with metastatic prostatic cancer, epithelial ovarian cancer, or malignant melanoma and is therefore used in both sexes. The adverse effects are very similar in men to those seen with oncological doses in women loss of libido and potency is likely to occur in male patients. In one clinical study of 43 men with recurrent and metastatic cancer of the prostate given megestrol acetate 160 mg/ day orally, five developed a symptomatic rise in liver... 

Acute rhabdomyolysis occurred in a 34-year-old woman with a melanoma treated with interferon alfa 20 MU/m / day (311). There was no recurrence on retreatment with a lower dose (down to 6.6 MU/m /day), suggesting that this was a dose-related complication. 

Figure 4.4 Example of longitudinal follow-up by plasma L-DOPA/L-tyrosine ratio. A 52-year-old male (initial melanoma right arm) was monitored by the L-DOPA/L-tyrosine ratio, SIOOB and melanoma inhibitory activity (MIA) for 21 months. Six major clinical events are reported 1, second local recurrence, 3 years after initial diagnosis 2, bone and pulmonary metastases (stage IV) 3, evolution of subcutaneous metastases 4, evolution of cutaneous and pulmonary metastases 5, metastases to axillary nodes 6, death...

The risk of relapse and death after the resection of a local or regional cutaneous melanoma is the primary determinant for the use of adjuvant therapy after primary resection. Adjuvant trials have focused on patients at intermediate or high risk of recurrence. 

Local recurrence is associated with aggressive tumor biology and is frequently a manifestation of an aggressive primary tumor. If a local recurrence occurs after inadequate primary disease, the patient should undergo a work-up based on the lesion thickness of the original melanoma. Patients with nodal recurrence should be evaluated for lymph node metastases. Patients with systemic recurrence should be evaluated and treated in a fashion similar to those patients presenting with systemic disease. 

Hydroxyurea, an antimetabolite with antineoplastic properties (60 to 80 mg/kg p.o. for a minimum of six weeks), is used in the treatment of melanoma chronic myelocytic leukemia recurrent, metastatic, or inoperable ovarian cancer squamous cell carcinoma of the head and neck polycythemia vera and essential thrombocytosis (see also Figure 15). 

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