Multidisciplinary management of special melanoma situations: Oligometastatic disease and bulky nodal sites

Sarnaik, Amod A.; Zager, Jonathan S.; Sondak, Vernon K.

doi:10.1007/s11912-007-0057-5

Cited by 12 publications

(7 citation statements)

References 44 publications

(37 reference statements)

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“…Current literature advocates that surgery should be the treatment of choice for bulky nodal melanoma in the absence of systemic metastases 10. Our data support this, and further suggest that resection of bulky melanoma is well tolerated and may have clinical benefit even in the presence of distant metastatic disease, especially as a palliative procedure.…”

Section: Discussionsupporting

confidence: 82%

Surgical resection for bulky or recurrent axillary metastatic melanoma

Shada

Walters

Tierney

et al. 2011

Journal of Surgical Oncology

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Introduction Metastatic melanoma has few FDA approved treatments, and aggressive surgical resection has to be considered for management of bulky axillary metastases. We hypothesized that axillary resection in this setting is well tolerated and improves symptoms in the majority of patients. Methods We reviewed a prospectively collected database and identified 47 stage IIIC and IV patients with axillary nodal disease greater than 5 cm (68%), recurrent disease (36%), or disease adherent to axillary neurovascular structures (45%). Paresthesias, pain, and bleeding were present in 40% of patients, and were stable or improved after surgery in 75%. Most patients were asymptomatic prior to resection, and underwent resection for prevention of potential symptoms. Results Most patients underwent outpatient surgery. Postoperative complications included lymphedema (34%), range of motion limitation (23%), wound infection (17%), and neuropathic pain (17%). Among symptomatic patients, average time to progression was 3 months, compared to 9.5 months in asymptomatic patients (P = 0.08). Five-year survival was lower (16%) in symptomatic patients than in asymptomatic patients (35%, P = 0.001). Discussion Surgery for bulky axillary melanoma metastases is well tolerated, and should be considered in the management of Stage III or IV melanoma. Resection prior to symptoms may improve quality of life and is associated with longer survival.

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Section: Discussionsupporting

confidence: 82%

Surgical resection for bulky or recurrent axillary metastatic melanoma

Shada

Walters

Tierney

et al. 2011

Journal of Surgical Oncology

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“…Quality of life indices are better in responders compared to supportive care, and responders are more likely to benefit from further treatments (12), as demonstrated in the present series. Surgery for responders may be of a lesser extent and less mutilating.…”

Section: Discussionsupporting

confidence: 77%

Multidisciplinary management of very advanced stage III and IV melanoma: Proof-of-principle

et al. 2012

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Abstract. Patients with potentially resectable advanced stage III and IV melanoma are a selected subgroup that gain maximal advantage if treated in a melanoma center. Surgery combined with chemo/chemobiotherapy may yield durable remission and long-term palliation. Thirty-seven non-randomly selected patients underwent systemic therapy with the aim of consolidating treatment by surgery. Data were collected prospectively, and analyzed retrospectively. The median follow-up from diagnosis was 50 (3-307) months and 15 (1-156) months when calculated from the last intervention. Twenty-two males and 15 females, with a median age at diagnosis of 44 (20-71) years, with 13 trunk, 13 extremity, 3 head and neck and 8 unknown primary melanomas were included. There were 17 stage III and 20 stage IV patients with a median Breslow thickness of 3.7 (0.45-26) mm. Chemo/ chemobiotherapy achieved 7 clinical complete responses (cCRs), 28 partial responses (PRs) and 2 instances of stable disease. Six of the 7 cCRs were operated on, securing pathological complete response in 5 and PR in one. Four of these five and the PR patient still have no evidence of disease (NED). Twenty-one of 30 PR patients were rendered NED by surgery; 14 of these 21 patients succumbed to melanoma, and one is alive with stable disease. Overall, 11 of 37 patients have not succumbed to melanoma, with a median of 72 (14-156) months survival following the last intervention. Of the eight patients with unknown primary melanomas, five have not succumbed to melanoma, with a median of 89 (30-156) months survival following the last intervention. Patients with marginally resectable stage III and IV melanoma have a significant 30% chance, according to this series, for durable remission if treated by a multidisciplinary team in a melanoma center using induction chemobiotherapy and surgery. Results are more favorable for patients with an unknown primary lesion. In view of the currently approved new effective treatments for melanoma, this study may be considered a proof-of-principle investigation, enabling long-term remissions by combining induction therapy and surgery. IntroductionBased on the 2006 Surveillance Epidemiology and End Results (SEER) database, the incidence of melanoma is 19.6 per 100,000 population per year in the US, with mortality rates at 2.7 per 100,000 (1). Rates in Israel are not significantly different with 1,200 new cases being reported per year per 7,000,000 population. The favorable incidence to mortality ratio reflects the fact that most melanoma patients are diagnosed at an early, surgically curable stage. Approximately 8,400 patients per year in the US either presented with or developed incurable disease, and succumbed to melanoma (1).Although surgery provides the best opportunity for cure, it is frequently futile or impossible in patients with advanced stage III or IV metastatic disease. Thus, a multidisciplinary approach is an option that should be applied to this subgroup of patients, in an attempt at improving their outcome.In their 1998 phase I...

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“…After careful consideration it may be reasonable to resect a single or localised liver metastasis. Completely resected single distant metastases may occasionally be associated with long survival [66, 67]. More common examples are symptomatic soft-tissue metastases.…”

Section: Surgery Of Distant Metastasesmentioning

confidence: 99%

Surgery and radiotherapy in the treatment of cutaneous melanoma

et al. 2009

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Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1–2 cm margins and primary closure. The recommended method of biopsy is excisional biopsy with a 2 mm margin and a small amount of subcutaneous fat. In specific situations (very large lesions or certain anatomical areas), full-thickness incisional or punch biopsy may be acceptable. Sentinel lymph node biopsy provides accurate staging information for patients with clinically unaffected regional nodes and without distant metastases, although survival benefit has not been proved. In cases of positive sentinel node biopsy or clinically detected regional nodal metastases (palpable, positive cytology or histopathology), radical removal of lymph nodes of the involved basin is indicated. For resectable local/in-transit recurrences, excision with a clear margin is recommended. For numerous or unresectable in-transit metastases of the extremities, isolated limb perfusion or infusion with melphalan should be considered. Decisions about surgery of distant metastases should be based on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases.

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Multidisciplinary management of special melanoma situations: Oligometastatic disease and bulky nodal sites

Cited by 12 publications

References 44 publications

Surgical resection for bulky or recurrent axillary metastatic melanoma

Surgical resection for bulky or recurrent axillary metastatic melanoma

Multidisciplinary management of very advanced stage III and IV melanoma: Proof-of-principle

Surgery and radiotherapy in the treatment of cutaneous melanoma

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