Surgery as Palliative Treatment for Distant Metastases of Melanoma

Abstract

Sixty-five patients with distant metastatic melanoma amenable to surgical treatment had excision of 94 metastatic lesions from the brain, lung, abdomen, distant subcutaneous sites, and distant lymph nodes. Relief of symptoms, if present, was obtained after excision of 77% of brain metastases, 100% of lung metastases, 88% of distant lymph node and subcutaneous metastases, and 100% of abdominal metastases. Median survival after excision of brain metastases was 8 months, lung metastases 9 months, abdominal metastases 8 months, and distant subcutaneous and lymph node metastases 15 months. Sixteen per cent of patients lived for 2 years of longer. These results demonstrated that surgery can achieve an effective local disease control in selected patients with distant melanoma metastases and that a few have a relatively long-term survival.

Long-Term Survival After Complete Resection of Melanoma Metastatic to the Adrenal Gland

“…These results concur with other series that demonstrate an improved survival in patients undergoing complete resection of metastatic melanoma in the lung, gastrointestinal tract, skin and subcutaneous tissue, distant nodes, and even brain. [1][2][3][4][5][6][7][8][9][10][11][12] Although not directly comparable with other studies, the median survival of 9.3 months for the total group is similar to that of patients with melanoma metastatic to the subcutis, 2,4 lung, 1,9,11,22,23 and gastrointestinal tract. 8,10 With the poor prognosis associated with stage IV melanoma, and no great impact from standard chemotherapy or radiotherapy, we will continue to investigate the role of adjuvant immunotherapy in the treatment of patients with stage IV disease.…”

“…3,5,7 However, surgical re- section can improve the outcome of occasional patients with isolated metastatic disease. In this series, only approximately 1 of every 5 patients with adrenal metastases could be rendered free of disease after adrenalectomy alone or in combination with an additional metastasectomy.…”

“…Most patients with metastatic melanoma are treated with chemotherapy; only a select group is eligible for surgical palliation of symptoms or potentially curative resection. Although retrospective evidence indicates improved survival of selected patients undergoing complete surgical resection of metastatic melanoma to isolated sites in the lung, gastrointestinal tract, and, occasionally, brain, [1][2][3][4][5][6][7][8][9][10][11][12] there are limited data on the role of surgery in patients with melanoma that has spread to the adrenal gland. 13 Recent studies have shown encouraging results for resection of clinically isolated adrenal metastases, but these are mostly from primary lung, kidney, and colorectal carcinomas.…”

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

“…Depending on overall extent of the disease as well as systemic and other treatment options, an individual approach is to be chosen for R1 and R2 residual tumors after surgical resection of distant metastases (stage IV) [78][79][80][81][82][83]. In a palliative situation, a decision should be made upon deliberation at an interdisciplinary tumor conference and in agreement with the patient.…”

Retrospective Reviews Can Be Learning Experiences

“…However, inclusion of the latter would be unethical. Wornom et al 6 reported, Ͼ1 decade ago, that the three prognostic factors influencing survival among patients with distant metastatic melanoma were (1) the number of metastatic sites (one vs. two vs. three), (2) the remission duration, and (3) the location of the metastasis (visceral vs. nonvisceral). Because of patient selection, almost all of their patients initially exhibited disease in one site and frequently that disease was a solitary metastasis.…”