Introduction

Melanoma is the eighth most common cancer in the US, accounting for 3% of cancers. In women it is increasing worldwide at a rate exceeding all other cancers except lung cancer. It has now become the leading cause of cancer mortality in the US for women aged 25–29 years.

The outlook for patients with advanced melanoma has traditionally been pessimistic. Indeed, despite recent advances in the understanding of its biology and immunology, patients whose tumor has spread beyond the primary site generally have a poor prognosis. However, as shall be discussed in this chapter, there is considerable palliative benefit to be gained from the appropriate use of surgery, chemotherapy, and radiotherapy. In addition, for the patient with advanced disease, the judicious use of these conventional modalities may lead to worthwhile disease-free survival. Newer treatments such as biochemotherapy and immunotherapy have also been widely tested in this setting and occasionally have resulted in the long-term survival of a small group of patients with advanced disease.

It is clear that patients with advanced melanoma should be managed in a multidisciplinary setting. In few other cancers is the involvement of such a range of specialists and professions as important. Primary care physicians, dermatologists, surgeons, medical oncologists, radiation oncologists, palliative care physicians, and clinical nurse specialists will all often be concerned with a patient at some time during the course of their disease.