Contemporary Surgical Treatment of Advanced-Stage Melanoma

Abstract

The clinical treatment of patients with stage IV melanoma according to criteria of the American Joint Committee on Cancer (AJCC) is controversial because the 5-year survival rate is approximately 5%. Specific clinicopathologic factors are predictive of survival following curative surgery. Design: Cohort analysis of 1574 successive patients undergoing surgical resection of metastatic melanoma for a 29-year period. Patients received follow-up on a routine basis with serial examinations and radiographic studies. The median follow-up time was 19 months (range, 1-382 months). Setting: Tertiary cancer center. Patients: Surgical resection was performed in 1574 patients. The decision to perform surgery was individualized for each patient. Intervention: The technique of surgical resection was based on the site of metastasis. Main Outcome Measure: Computer-assisted database with statistical analyses using log-rank tests and Cox regression models. Results: Of the 4426 patients with AJCC stage IV melanoma, 1574 (35%) underwent surgical resection;

Acute Liver Failure Associated with Diffuse Hepatic Infiltration of Malignant Melanoma of Unknown Primary Origin

“…Hepatic resection offers the possibility of long-term survival in patients with liver-limited metastasis (14). In patients with unresectable melanoma, empirical systemic chemotherapy is the best treatment option, if their performance status is adequate.…”

Surgical Management of Malignant Melanoma

“…Cloquet lenf nodu biyopsisi mikroskopik hastalık varlığında, dördün altında lenf nodu tutulumunda veya klinik lenf nodu tutulumu olmadığında önerilmektedir. Chu ve arkadaşları, tamamlayıcı yüzeyel inguinal diseksiyon sonrası senkron pelvik hastalık görülme oranını %11,9 olarak (52). 1 yıllık sağkalım %50 civarındadır.…”

Challenging Problems in the Surgical Management of Melanoma

“…When complete resection is performed in the setting of distant disease, five-year survival rates in the range of 20-25%, and as high as 40%, may be achieved . Importantly, one study showed that, while patients who undergo complete resection of metastatic melanoma have a 5 year survival rate of 23%, the figure was 6% in patients who either do not undergo surgery or have gross residual disease remaining following surgery (R2 resection) [Agrawal et al, 1999;Essner et al, 2004;Ollila et al, 1996;Rose et al, 2001].…”

“…For example, patients with a disease-free interval of greater than 36 months at the time of recurrence and those with a solitary metastasis have better outcomes a [Essner, 2003;Essner et al, 2004]. Tumor doubling time has also been correlated with prognosis; a tumor doubling time of greater than 60 days is associated with a more favorable prognosis relative to a shorter doubling time [Ollila et al, 1998].…”