This issue marks the 30th anniversary of The Melanoma Letter. It’s an occasion to reflect on the sweeping changes in melanoma prevention, diagnosis, and treatment since the publication began, which have been reflected in its pages. In our first two decades, we ran some of the earliest articles on dermatoscopy and the then fledgling prognostic method sentinel lymph node biopsy, when they were little-used and much-debated; our updates over the years reflected their development into state of the art strategies. We tracked the epidemic increases in melanoma incidence and mortality, the morbidity-sparing modifications in surgical margins, the arrival of Mohs surgery, new and newer staging guidelines, and many other major milestones.
But perhaps nothing in our pages has better reflected the dynamic evolution of melanoma care than the advent of immunotherapy. Early on, we ran articles describing the tantalizing possibilities of interferon, interleukin, and monoclonal antibodies, little knowing how quickly these strategies would lead to landmark treatments. In 1996, Kirkwood, et al reported to us on the FDA’s approval of interferon alfa-2b, the first ever FDA-approved adjuvant biological therapy for high-risk melanoma patients. In 1998, Michael Atkins described the newly FDA-approved high-dose Interleukin-2 regimen, the first ever for Stage IV patients. Until this past year, these were the only immunotherapies approved for melanoma.
While these therapies were bonafide ‘breakthroughs,’ they resulted in cures for only a tiny fraction of patients. Now, immunotherapy has taken another quantum leap with last year’s approval of ipilimumab (YervoyTM). In our lead article, Drs. Michael Postow and Jedd Wolchok explore the great promise ipilimumab holds for so many patients with advanced melanoma. They describe the relative rapidity with which immune checkpoint blockade was developed and brought to the clinic with ipilimumab, and expertly summarize the clinical considerations with this drug and its limitless potential, especially in combination with other agents.
In our second story, Dr. Sanjiv Agarwala reviews the gradual evolution of intralesional therapy for cutaneous melanoma metastases and describes the recent resurgence of Rose Bengal (PV-10) as an intralesional agent. Although systemic therapies harnessing the immune system’s ability to combat and potentially cure melanoma have rightfully generated tremendous excitement, we need to remember that palliative treatments such as intralesional therapy still hold a vital place in our armamentarium. While we work toward cures, a significant subset of melanoma patients benefit greatly from the varied approaches to management of what can be devastating and incapacitating cutaneous metastases.
Over the past 30 years, if anything, we have observed that not all new scientific knowledge, including 'breakthrough' research, translates into dramatic patient gains. But even the smallest advances can, in their aggregate, improve and sometimes save the lives of patients, or at the very least, pave the way for advances that will improve or save the lives of patients. For three decades now, we have tried to keep our ever-growing readership abreast of these never-ending developments, large and small, in an accessible and timely way.
Allan C. Halpern, MD
Ashfaq A. Marghoob, MD