The clinical use of molecular markers as predictors of disease outcome and response to therapy in malignant melanoma

Advances in surgical technique, diagnostic imaging, and adjuvant therapy have changed the management of melanoma patients during the last 20 yr. Despite this, several challenges remain. Attempts at using radiographic and nuclear medicine imaging to diagnose disease progression and metastatic disease at a stage early enough to affect survival have not been successful. Similarly, a reliable method of predicting or monitoring response to adjuvant therapy is currently unavailable. The last decade has seen the development of multiple RNA and DNA markers that have been applied toward the diagnosis/detection of occult disease, prediction of survival, disease surveillance, or as indicators of response to adjuvant therapy. Molecular markers may represent tumor-associated antigens, tumor suppressor genes, oncogenes, cell physiological and transcription factors, or cellular apoptotic mediators. Genomic DNA and RNA molecular markers have been applied to melanoma primary tumors, regional and visceral metastases, serum, cerebral spinal fluid, and bone marrow. The ability to use molecular markers as prognostic indicators will be invaluable as clinicians seek to stratify patients for clinical trials, adjuvant treatments, and clinical follow-up regimens.