Immunotherapy using a variety of agents may be beneficial in controlling accessible cutaneous melanoma metastases and may have potential for limiting the growth of systemic disease when used in the adjuvant setting. Approximately 20% of patients with metastases limited to the skin can be brought into complete remission with local, intralesional BCG immunotherapy. Dinitrochlorobenzene (DNCB), vaccinia virus, C. parvum, and transfer factor have also been tested for activity in local immunotherapy. BCG, DNCB, and vaccinia virus appear to be the most effective. Adjuvant immunotherapy has shown some promise, particularly with regard to improvement in survival. In a study of adjuvant immunotherapy with BCG in patients with stage II disease, recurrence rates were similar, but of those patients who developed recurrences, those who received BCG lived significantly longer. Immunotherapy, used either alone or in combination with chemotherapeutic agents, has shown little or no activity in the treatment of metastatic malignant melanoma.
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