From the Editor's Desk

Adam I. Riker

I am pleased to bring to our readers a series of timely and interesting articles focused on several aspects of human melanoma. As many readers know, the incidence of melanoma in the United States is reaching epidemic proportions, highlighting the importance of minimizing our risk by all possible methods available to us. We begin this dedicated issue on melanoma with a review of the early detection and prevention of melanoma, with an overview of the currently available evidence on the causes of melanoma and detection methods. This article stresses the dangers of indoor tanning, providing an update of current legislation and laws in place that will hopefully curtail its use by minors. The next article, from Australian colleagues, highlights several pathologic issues in diagnosing melanocytic skin lesions, both benign and malignant. They discuss nevi that are prone to misdiagnosis, difficult to diagnose variants of cutaneous melanoma, and pitfalls and approaches to such skin lesions.

Matta et al present an original research article that shows the critical role of DNA repair capacity in cutaneous melanoma in a Puerto Rican population. They provide important insight into the non-caucasian populations that are least studied, analyzing the DNA repair capacity of this minority population in a geographic area chronically exposed to some of the highest levels of ultraviolet radiation in the world. Next, Howell and colleagues provide novel insight into a relatively new area of melanoma research: microRNA and its involvement in melanoma. Little research into this exciting field has been conducted until recently, with several researchers identifying key microRNAs involved in the malignant transformation and progression of melanoma. They also discuss the influence of key microRNA upon microphthalmia-associated transcription factor, deemed a “master regulator” gene in human melanoma. Several overlapping and parallel molecular pathways that are important in melanoma progression are nicely described by our colleagues at the University of California, San Francisco. The molecular pathogenesis and mutational analysis of melanoma have provided us with key details of specific pathways and gene mutations that have allowed us to develop several targeted therapies aimed at such defects. Many of these are gene and/or mutational specific, acting on the main signaling cascade, the RAS-RAF-MAP kinase pathway.

Love and Delman contribute a fresh insight into the regional management of nodal disease. They have developed a modified approach of videoscopic inguinal dissection for those melanoma patients requiring a completion inguinal lymphadenectomy. This new approach may greatly reduce many of the complications associated with the open procedure. Next, authors from the Cutaneous Oncology Program at the Moffitt Cancer Center in Tampa discuss two important topics in the management of advanced melanoma. The first is the management of the melanoma patient who has been surgically resected and therefore rendered without evidence of disease but nonetheless remains at a very high risk of systemic recurrence. This large group of patients presents a dilemma to clinicians, as mere observation clearly seems insufficient given the natural history of advanced melanoma. Treatment options for such patients are further discussed, with the final article by Kudchadkar discussing the latest therapies for patients with metastatic melanoma.

In conclusion, I am honored to present to you, the reader, a compilation of articles focused on melanoma. As a clinician who specializes in this field, it is both very exciting and frustrating, with the excitement in novel targeted therapies having response rates greatly exceeding those of anything available in the past. The frustration comes when we are unable to help our patients with advanced disease due to antiquated chemotherapy regimens or a lack of clinical trials in which the patient lives. We must continue to impress upon everyone the need for continued research funding and support in order to develop the translational research and clinical trials utilizing novel agents for this lethal cancer. Please enjoy this edition of The Ochsner Journal.