The mechanisms of action of tamoxifen, either singly or in combination with 
other chemotherapeutic agents, is still unclear. However, Cocconi et al ( 6) 
have concluded that dacarbazine and tamoxifen should now be considered 
standard therapy for patients with metastatic melanoma. Further, they suggest 
that tamoxifen, a mixed estrogen agonist and antagonist, modulates the 
cytotoxic effects of chemotherapy through an estrogen-dependent mechanism. 
2.3 Immunotherapy of Melanoma: Metastatic melanoma has been a major target 
for tumor immunotherapy because of the well documented occurrence of 
spontaneous regression, the demonstrated detection of melanoma associated 
antigens (MAA) both in patients and in experimental animals, the ready 
availability of tumor tissue, and the lack of routinely effective therapeutic 
options. Early trials focused on active non-specific immunostimulation with 
microorganisms or their constituents (7) . With the exception of int ralesional 
BCG therapy for regional intradermal metastases, there was little success and 
interest waned. Advances in basic immunobiology and molecular biology have 
rekindled activity, and several conceptually appealing approaches have 
evolved. 
2.4 Immunotherapy Studies: Immunotherapy for the treatment of malignant 
melanoma has been attempted previously. Recent efforts are summarized in the 
following Table. 
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