Topical dinitrochlorobenzene combined with systemic dacarbazine in the treatment of recurrent melanoma.

Fifty-nine selected patients with recurrent melanoma (37 locoregional and 22 locoregional and haematogenic) were treated with a combination of topical dinitrochlorobenzene (DNCB) and systemic dacarbazine (DTIC). The observations were analysed retrospectively. Fifteen patients (25%) (one third with distant spread) experienced a complete response, with a median duration of 10 months (range 3-210 months). Five of these patients, three of them with haematogenic disease, showed prolonged disease-free survival (85, 156, 170, 177 and 210 months). Seven patients (12%) obtained a partial response, and no response was seen in the remaining 37 patients (63%). In the presence of a severe local reaction to topical DNCB application the median survival was 12 months compared with 7 months in cases with a slight or moderate local reaction (P=0.0013). Patients showing a response to the DNCB-DTIC combination had a median survival of 18 months versus 7 months for the non-responders (P<0.0003). In view of the prolonged survival in five patients, this combined treatment schedule yields promising results in the treatment of selected melanoma patients with cutaneous recurrences, whether or not these are associated with other metastases.