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Malignant melanoma of the skin is the most frequent cause of mortality in skin cancer. Despite various efforts toward increased early detection and prevention of melanoma, approximately 20% of patients will die because of disseminated metastases. Once melanoma has spread to regional lymph nodes, survival diminishes to approximately 30%–55% depending on micro- or macrometastases and the number of involved nodes. It is well established that the tumour load within the lymph node or nodes is an important predictor for disease-free survival (dfs) and overall survival (os). Median survival for stage iv melanoma patients ranges from 6 months to 12 months, and to date, fewer than 10% of all stage iv patients demonstrate long-term survival. The poor outcome for patients with advanced metastatic melanoma indicates an urgent need for effective adjuvant treatment modalities for patients with high-risk disease.  Since the 1970s, dozens of prospective randomized controlled clinical trials for intermediate- and high-risk melanoma patients have been performed. In contrast to the situation with other solid malignancies such as breast and colorectal cancer, no global consensus has been reached on an effective adjuvant treatment for melanoma patients1.  Approaches using unspecific immunostimulation (bacille Calmette–Guerin, among others), interferon γ, conventional chemotherapy, and vaccination have not been demonstrated to improve dfs or particularly os in comparison with untreated controls2.  Therefore, even in the year 2009, interferon alfa is the only agent being used in adjuvant treatment for melanoma that has showed at least a positive effect on relapse-free survival (rfs)—and in the case of high-dose interferon alfa (hdi), also a positive effect on os. However, those benefits provide only a modest improvement of rfs in the range of 5%–10% and os in the range of 2%–5%. However, the data are robust, given that the results of a meta-analysis also demonstrated statistically significant benefits for interferon-treated as compared with untreated patients3.

Adjuvant Interferon Alfa for Melanoma: New Evidence-Based Treatment Recommendations?