General Comments: Cytokines may cause side effects such as chills, aches, fever, severe fatigue, and swelling.

Medication or Drug Class




Chemotherapeutic agents

Immunotherapy (adjuvant immunotherapy with cytokines)

Varies with drug

Varies with drug

"Dartmouth Regimen": dacarbazine (DTIC), carmustine, cisplatin, and tamoxifen Other: cisplatin, vinblastine, DTIC Interferon-alpha; interleukin-2

Decrease replication of malignant cells and kill them

Enhances immune system to recognize and destroy cancer cell; shrinks metastatic melanomas (effective in 10%- 20% of patients)


Patient and family education is the most important nursing responsibility in preventing, recognizing, and treating the disorder. Educational materials and teaching aids are available from various community and national organizations, the local or state branch of the American Cancer Society, and online computer services. Nursing care of patients who have had surgery is focused on patient education because most of these patients are treated in an ambulatory or short-term stay setting. Instruct patients to protect the site and inspect the incision and graft sites for bleeding or signs of infection. Immobilize recipient graft sites to promote engraft-ment. Evaluate limbs that have surgical incisions or local isolated chemotherapy to prevent edema.

Reactions to skin disfigurement that occur with some treatments may vary widely. Determine what the cancer experience means to the patient and how it affects the patient's perception of his or her body image. Help the patient achieve the best possible grooming as treatment progresses. Suggest a support group, or if the patient is coping ineffectively, refer for counseling.

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