CRD Summary: The authors concluded that outcomes were generally poor with dacarbazine treatment for metastatic melanoma. They also found that the addition of other therapies offered minimal clinical advantages and that included trials were generally small and of poor quality. These findings are likely to be reliable but should be interpreted with some caution due to lack of details on data synthesis.

CRD Commentary: The review addressed a focused question, supported by defined inclusion criteria. The literature search was adequate but the review was restricted to published studies, so there is a possibility of publication bias. Appropriate steps were taken to minimise bias and errors in the selection of studies and extraction of data, but it was unclear whether such steps were also taken to the assessment of study quality. The quality assessment considered some appropriate criteria but consideration of other potential biases, such as concealment of treatment allocation, would have been preferable. Trial details were adequately presented in tables, but further details on the study participants would have helped determine the generalisability of results. The methods used to pool response rate data appeared appropriate, but detail was lacking on the treatment of survival data, for example, how duration of survival was compared between groups was not reported. The authors' conclusions are likely to be reliable but should be interpreted with some degree of caution due to the limited reporting of synthesis methods.