Biochemotherapy (chemotherapy with cytokines IL-2 and IFN-α) combined with BRAF inhibitors improved survival for people with BRAF positive melanoma. Biochemotherapy alone did not improve overall survival and had higher toxicity than chemotherapy. Combining multiple chemotherapy agents (polychemotherapy) did not improve survival over monochemotherapy. Targeted therapies result in relatively short progression-free survival (PFS) times. The therapy combination of dabrafenib and trametinib has a 3-year PFS of 23%, and 5-year PFS of 13%. Immunotherapy
Immunotherapy is aimed at stimulating the persons immune system against the tumor, by enhancing the bodys own ability to recognize and kill cancer cells. The current approach to treating melanoma with immunotherapy includes three broad categories of treatments including cytokines, immune check point inhibitors, and adoptive cell transfer. These treatment options are most often used in people with metastatic melanoma and significantly improves overall survival. However, these treatments are often costly. For example, one immune check point inhibitor treatment, pembrolizumab, costs $10,000 to US$12,000 for a single dose administered every 3 weeks.Cytokine therapies used for melanoma include IFN-a and IL-2. IL-2 (Proleukin) was the first new therapy approved (1990 EU, 1992 US) for the treatment of metastatic melanoma in 20 years. IL-2 may offer the possibility of a complete and long-lasting remission in this disease in a small percentage of people with melanoma. Intralesional IL-2 for in-transit metastases has a high complete response rate ranging from 40 to 100%.
Desmoplastic melanoma
Melanoma with small nevus-like cells
Melanoma with features of a Spitz nevus
Uveal melanoma
Vaginal melanoma
Polypoid melanoma, a subclass of nodular melanoma. In situ or invasive
A melanoma in situ has not invaded beyond the basement membrane, whereas an invasive melanoma has spread beyond it. Some histopathological types of melanoma are inherently invasive, including nodular melanoma and lentigo maligna melanoma, where the in situ counterpart to lentigo maligna melanoma is lentigo maligna. Lentigo maligna is sometimes classified as a very early melanoma, and sometimes a precursor to melanoma.Superficial spreading melanomas and acral lentiginous melanomas can be either in situ or invasive, but acral lentiginous melanomas are almost always invasive. Staging
Further context on cancer staging is available at TNM. Metastatic melanomas can be detected by X-rays, CT scans, MRIs, PET and PET/CTs, ultrasound, LDH testing and photoacoustic detection. However, there is lack of evidence in the accuracy of staging of people with melanoma with various imaging methods.Melanoma stages according to AJCC, 8th edition:
TX: Primary tumor thickness cannot be assessed (such as a diagnosis by curettage)
T0: No evidence of primary tumor (such as unknown primary or completely regressed melanoma)Stage 1 and 2 require an N (lymph node) class of:

N0 – No regional metastases.Stage 1, 2 and 3 require an M (metastasis status) of:

M0: No evidence of distant metastasisOlder systems include "Clark level" and "Breslows depth", quantifying microscopic depth of tumor invasion.