In this edition of The Melanoma Letter, we diverge from our usual attempt to provide objective coverage of clinical advances and important research. Instead, we have invited Dr. Vivian Bucay to provide a detailed and very personal account of her battle with melanoma over the past two years. Her insights as an expert coupled with her experiences as a patient give her report a powerful immediacy as she touches on the wide range of diagnostic tests and treatments, both traditional and experimental, currently available for metastatic melanoma.

While we often lament in these pages the lack of highly effective treatments for advanced melanoma, Dr. Bucay's story personalizes the hopes of patients and their physicians in their search for effective therapies.While to date the majority of patients may find improved diseasefree survival at best, some persistent, fortunate souls will indeed experience remission and even dare we say "cure."

In sharing her story, Dr. Bucay reminds us that at the level of the individual patient, the statistics we often cite on prognosis and therapeutic response can be quite misleading. This point was well articulated by evolutionary biologist and science historian Stephen J. Gould, who was diagnosed with peritoneal mesothelioma, a deadly form of cancer that destroys the abdominal lining. When he learned that mesothelioma patients had a median lifespan of only eight months, he wrote a wonderful piece for Discover magazine, "The Median Isn't the Message," in which he noted that while half of all mesothelioma patients die before 8 months, some live much longer. After two difficult years of experimental treatment, he experienced a full remission.

Dr. Bucay's story echoes Gould's message that even in the face of dire statistics, patients often find reason to hope. It also reminds us that therapeutic interventions are continuously evolving. For example, the long-held belief that elective lymph node dissection improves survival eventually proved false, but knowledge gained from the research led surgeons to abandon ELND in favor of SLNB, which we now know provides valuable prognostic information. And while interferon has not proven to extend overall survival, investigating the effects of interferon has opened up new avenues of research aimed at harnessing the power of the body's immune system. Even our 'failed' therapies have benefited some patients; on the basis of those few successes the promise of better therapies grows.

Allan C. Halpern, MD, Editor-in-Chief
Ashfaq A. Marghoob, MD, Associate Editor