Melanoma is often incorrectly perceived as a radiation-resistant tumor. Although curative therapy usually relies on surgical interventions, circumstances may arise where surgical intercession is not ideal, convenient, or even possible. In such situations, other modes of therapy such as topical immunomodulation, cryotherapy, or radiation therapy may provide alternatives, which in select cases may prove curative.

In this issue of The Melanoma Letter, Drs. Isaac Brownell, Nancy Lee, and Alice Ho at Memorial Sloan-Kettering Cancer Center explore the uses of superficial radiotherapy in treating certain types of melanoma. The technique can serve as an adjuvant therapy to regional lymph node basins in select patients at high risk for regional recurrence, as a palliative therapy for disseminated inoperable disease, and in select cases, as a primary therapy for lentigo maligna and lentigo maligna melanoma as well as unresectable in-transit metastases.  Dr. Reinhard Dummer also details the experience of European clinicians using superficial radiotherapy to treat LMM.

While curative therapy for melanoma remains of paramount importance, the value of palliative therapy and treatments aimed at prolonging life cannot be underestimated. One of the most dreaded sequelae of advanced melanoma is metastasis of the tumor to the brain. Although brain metastasis is generally associated with a poor prognosis, some patients respond well, and a few can manifest durable responses to systemic therapy and/or radiotherapy. In this issue, Drs. Ashwatha Narayana, Anna Pavlick, and John Golfinos at New York University Medical Center describe their use of radiotherapy and radiosurgery in the treatment of melanoma brain metastasis.