The role of surgery in treatment of stage IV melanoma

Abstract

The prognosis for patients with melanoma has not improved over the last 30 years. So far, almost without exception, clinical trials conducted with single or multiple agent chemotherapy, biological therapy (interferon-alpha, interleukin-2), and biochemotherapy have failed to demonstrate consistent survival benefit. Without effective alternate treatments, surgery must be considered the primary treatment of melanoma, independent of disease stage. Although surgery is clearly favored as the treatment of localized melanoma, consensus opinion and clinician preference become divided once melanoma progresses beyond its primary site. Many physicians will adopt an attitude of resignation and hesitancy when treating metastatic melanoma. As a result, patients with advanced disease are often treated with medications that produce little survival or palliative benefit at the expense of significant toxicity. Numerous studies have demonstrated clear and durable survival advantages for patients undergoing complete resection of metastatic melanoma. Further, surgical resection can produce an immediate decrease in tumor burden with minimal morbidity and mortality at a reasonable cost.

Surgery and adjuvant therapies in the treatment of stage IV melanoma: our experience in 84 patients

“…Systemic therapies, after radical or cytoreductive surgery, seem to obtain encouraging results [4,5].…”

Targeted delivery of transferrin and TAT co-modified liposomes encapsulating both paclitaxel and doxorubicin for melanoma

“…Usually melanoma could not be cured totally by surgical removal of the tumor or traditional chemotherapy (Young et al, 2006). As the surgical treatment is too difficult to guarantee clearing the tumor completely, and non-selective anti-cancer drugs would cause huge cytotoxicity to the normal cells.…”

Challenging Problems in the Surgical Management of Melanoma

“…Factors that are positively associated with prognosis for resection of lung metastasis are ability to perform complete resection, a prolonged diseasefree interval, one or two pulmonary nodules, prior response to chemotherapy, negative lymph nodes, and the absence of extrathoracic disease [Harpole et al, 1992;Petersen et al, 2007]. Metastasectomy is associated with a median survival of 20 months compared with only 7.2 months for patients who do not undergo surgical resection [Young et al, 2006]. When there is metastasis to the gastrointestinal tract, surgery is often limited to palliative measures for patients experiencing perforation, obstruction, or bleeding.…”

“…solitary metastasis) with acceptable risk [Schuchter et al, 2000;Wood et al, 2001]. The median survival for patients with gastrointestinal metastases is 5-11 months [Panagiotou et al, 2002], but there are reports of survival of many years in a minority of patients [Young et al, 2006]. Cholecystectomy, liver resection, pancreaticoduodenectomy, or other complex pancreaticobiliary surgical procedures may also be indicated for metastatic melanoma to those sites [Carboni et al, 2004;Cellerino et al, 2000;Rose et al, 2001].…”