Cure of cutaneous melanoma

The article by J Merion Thomas & colleague is very welcome as a
position statement on this ill understood cancer. But the authors make
clear that the increased incidence of the disease is running ahead of any
very minor therapeutic advances made in the past decade.

If we want to make progress with melanoma we need to get away from
the 'chop it out' (surgery) and 'poison it' (oncology) philosophies which
we still cling to, and ask much more fundamental questions. Professor
Gerry Milton, former much respected chief of the Sydney Melanoma Unit used
to teach that the events which determine the behaviour of a melanoma have
probably occurred many years before the development of the clinically
obvious tumour.

We make the assumption, for example, that thin tumours progress to
thick ones, and therefore that early diagnosis definitely helps. This is
by no means certain as no-one, quite rightly, has ever sat watching a
melanoma once diagnosed. The two may represent entirely different animals.

Thomas also quite rightly (at least on present knowledge) observes
that exposure to sunlight is the only known controllable factor in
prevention. But which aspect of sunlight? For example, are we right in
thinking that it is the visible component (a tiny fraction) of the solar
radiation spectrum which causes the damage? Some components of cosmic
radiation can pass through brick walls and more, and this might well
explain why Australian research shows as high an incidence of melanoma on
skin protected by clothing as on exposed areas.

All in all, we need a much more holistic and lateral thinking
approach to the aetiology of this tumour, including asking difficult
questions about the way the actions of world governments in dealing with
environmental issues and the depletion of the ozone layer may be affecting
what is in some ways becoming an oncological emergency.

Competing interests:
None declared