Management of in-transit metastases from cutaneous malignant melanoma

Abstract

In-transit metastases carry a poor prognosis. The method of treatment should be tailored to the extent of cutaneous disease. The first line of treatment remains complete excision with negative histopathological margins. There is no need for wide excision. Carbon dioxide laser therapy is valuable for multiple small cutaneous deposits. Isolated limb perfusion has a role for numerous or bulky advanced in-transit metastases in the limbs that are beyond the scope of simpler techniques. Systemic chemotherapy has response rates of about 25 per cent and is reserved for patients for whom surgery is no longer feasible.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Individual patterns of metastatic dissemination and rapidity of progression vary greatly. Recurring metastases may be treated with a host of therapeutic methods such as surgery, CO2 laser ablation, cryotherapy, intralesional injections, regional drug therapy, immunomodulating agents, or radiation therapy [419,435]. There is no evidence for the superiority of one method over the other or for potentially better results than through surgery, if an R0 resection is technically feasible [88].…”

“…At any rate, it should be considered prior to limb amputation (e.g. because of ulceration of recurrent melanoma) [435,438].…”

Current Controversies in the Surgical Management of Melanoma

“…In-transit metastases are defined as cutaneous or subcutaneous deposits of melanoma between the site of primary disease and regional lymph nodes (Hayes et al, 2004). Deposits may be localized around the primary tumour, may be widespread throughout the affected limb, or on the head, neck or trunk, depending on the primary site.…”

“…Deposits may be localized around the primary tumour, may be widespread throughout the affected limb, or on the head, neck or trunk, depending on the primary site. The number of deposits generally increases over time (Hayes et al, 2004). They are thought to arise from dissemination of melanoma cells via lymphatics to tissues located primarily between the primary tumour and the regional lymph node basin.…”

“…In its most severe form, in-transit metastasis may become severely disabling and may be refractory to treatment. Treatment is therefore, palliative, even if staging investigations fail to show evidence of distant metastatic disease (Hayes et al, 2004). Recent studies have recommended that treatment should be tailored to the extent of the disease, with treatments associated with significant morbidity being reserved for bulky advanced metastases (Hayes et al, 2004).…”