The progestogen megestrol acetate (160 mg/day PO continuously starting 2 days before chemotherapy) plus chemotherapy with dacarbazine (220 mg/m2/day IV for 3 days), cisplatin (25-30 mg/m2/day IV for 3 days) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) were administered to 22 patients, 18 of whom were evaluable. Toxicity was tolerable, and more than 80% of ideal dosing was achieved during the first two cycles of treatment. A net weight gain of 0.95 kg was observed during this program of treatment. A 56% objective response rate, including visceral responding sites, with a median duration of response of 37.5+ weeks was achieved. A median survival of 15 months for all evaluable study patients was seen, which is somewhat longer than that achieved by most prior studies, including those employing the same chemotherapy regimen plus tamoxifen. Megestrol acetate may contribute to a high objective response rate and prolonged median survival in viscerally dominant metastatic melanoma when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.