Skip to main content
SpringerLink
Log in

The surgical management of metastatic melanoma

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

When deciding whether or not to perform a resection for metastatic melanoma, one should follow general principles that apply to the patient with melanoma as well as to the patient with metastases from other types of primary tumors. When the resection is palliative, the success of surgical treatment will be governed by the presence of identifiable symptoms, the morbidity of the procedure, the course of the disease, and the ability to communicate treatment goals among surgeon, patient, and family. When the resection is performed with curative intent long-term survival depends on the ability of the surgeon to select patients with a pattern of recurrence suggestive of a less aggressive tumor biology. Regardless of the extent of the operative procedure, resection of metastases in patients whose disease recurs early after the treatment of the primary tumor, in those who present with multiple lesions, and in those who present with disease that cannot be completely resected will only rarely be associated with subsequent long-term survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reintgen, DS, Vollmer R, Tso CY, Seigler HF. Prognosis for recurrent stage I malignant melanoma.Arch Surg 1987;122:1338–42.

    PubMed  CAS  Google Scholar 

  2. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma.J Clin Oncol 2001;19:3635–48.

    PubMed  CAS  Google Scholar 

  3. Balch CM. Surgical management of regional lymph nodes in cutaneous melanoma.J Am Acad Dermatol 1980;3:511–24.

    Article  PubMed  CAS  Google Scholar 

  4. Markowitz JS, Cosimi LA, Carey RW, et al. Prognosis after initial recurrence of cutaneous melanoma.Arch Surg 1991;126:703–7.

    PubMed  CAS  Google Scholar 

  5. Coit DG, Rogatko A, Brennan MF. Prognostic factors in patients with melanoma metastatic to axillary or inguinal lymph nodes. A multivariate analysis.Ann Surg 1991;214:627–36.

    Article  PubMed  CAS  Google Scholar 

  6. Morton DL, Wanek L, Nizze JA, Elashoff RM, Wong JH. Improved long-term survival after lymphadenectomy of melanoma metastatic to regional nodes. Analysis of prognostic factors in 1134 patients from the John-Wayne Cancer Clinic.Ann Surg 1991;214:491–9.

    Article  PubMed  CAS  Google Scholar 

  7. Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multifactorial analysis of melanoma. IV. Prognostic factors in 200 melanoma patients with distant metastases (stage III).J Clin Oncol 1983;1:126–34.

    PubMed  CAS  Google Scholar 

  8. Am MH, Al Sarraf M, Vaitkevicius VK. Clinical presentation, natural history and prognostic factors in advanced malignant melanoma.Surg Gynecol Obstet 1979;149:687–92.

    Google Scholar 

  9. Roses DF, Karp NS, Oratz R et al. Survival with regional and distant metastases from cutaneous malignant melanoma.Surg Gynecol Obstet 1991;172:262–8.

    PubMed  CAS  Google Scholar 

  10. Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases.J Am Coll Surg 1995;181:193–201.

    PubMed  CAS  Google Scholar 

  11. Leo F, Cagini L, Rocmans P, et al. Lung metastases from melanoma: when is surgical treatment warranted?Br J Cancer 2000;83:569–72.

    Article  PubMed  CAS  Google Scholar 

  12. Eton O, Legha SS, Moon TE, et al. Prognostic factors for survival of patients treated systemically for disseminated melanoma.J Clin Oncol 1998;16:1103–11.

    PubMed  CAS  Google Scholar 

  13. Brand CU, Ellwanger U, Stroebel W, et al. Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors.Cancer 1997;79:2345–53.

    Article  PubMed  CAS  Google Scholar 

  14. Deichmann M, Benner A, Bock M, et al. S100-Beta, melanoma-inhibiting activity, and lactate dehydrogenase discriminate progressive from nonprogressive American Joint Committee on Cancer stage IV melanoma.J Clin Oncol 1999;17:1891–6.

    PubMed  CAS  Google Scholar 

  15. Franzke A, Probst-Kepper M, Buer J, et al. Elevated pretreatment serum levels of soluble vascular cell adhesion molecule 1 and lactate dehydrogenase as predictors of survival in cutaneous metastatic malignant melanoma.Br J Cancer 1998;78:40–5.

    PubMed  CAS  Google Scholar 

  16. Krouse RS, Nelson RA, Farrell BR, et al. Surgical palliation at a cancer center: incidence, and outcomes.Arch Surg 2001;136:773–8.

    Article  PubMed  CAS  Google Scholar 

  17. Wornom IL III, Smith JW, Soong SJ, McElvein R, Urist MM, Balch CM. Surgery as palliative treatment for distant metastases of melanoma.Ann Surg 1986;204:181–5.

    Article  PubMed  Google Scholar 

  18. Cady B. Basic principles in surgical oncology.Arch Surg 1997;132:338–46.

    PubMed  CAS  Google Scholar 

  19. Karakousis CP, Temple DF, Moore R, Ambrus JL. Prognostic parameters in recurrent malignant melanoma.Cancer 1983;52:575–9.

    Article  PubMed  CAS  Google Scholar 

  20. Harpole DH Jr, Johnson CM, Wolfe WG, George SL, Seigler HF, Analysis of 945 cases of pulmonary metastatic melanoma.J. Thorac Cardiovasc Surg 1992;103:743–8.

    PubMed  Google Scholar 

  21. Rose DM, Essner R, Hughes TM, et al. Surgical resection for metastatic melanoma to the liver the John Wayne Cancer Institute and Sydney Melanoma Unit experience.Arch Surg 2001;136:950–5.

    Article  PubMed  CAS  Google Scholar 

  22. Agrawal S, Yao TJ, Coit DG. Surgery for melanoma metastatic to the gastrointestinal tract.Ann Surg Oncol 1999;6:336–44.

    Article  PubMed  CAS  Google Scholar 

  23. Ollila DW, Hsueh EC, Stern SL, Morton DL. Metastasectomy for recurrent stage IV melanoma.J Surg Oncol 1999;71:209–13.

    Article  PubMed  CAS  Google Scholar 

  24. Berman C, Reintgen D. Radiologic imaging in malignant melanoma: a review.Semin Surg Oncol 1993;9:232–8.

    PubMed  CAS  Google Scholar 

  25. Gokaslan ZL, Aladag MA, Ellerhorst JA. Melanoma metastatic to the spine: a review of 133 cases.Melanoma Res 2000;10:78–80.

    PubMed  CAS  Google Scholar 

  26. Felix EL, Sindelar WF, Bagley DH, Johnston GS, Ketcham AS. The use of bone and brain scans as screening procedures in patients with malignant lesions.Surg Gynecol Obstet 1975;141:867–9.

    PubMed  CAS  Google Scholar 

  27. Muss HB, Richards F, Barnes PL, Willard VV, Cowan RJ. Radionuclide scanning in patients with advanced malignant melanoma.Clin Nucl Med 1979;4:516–8.

    PubMed  CAS  Google Scholar 

  28. Jadvar H, Johnson DL, Segall GM. The effect of fluorine-18 fluorodeoxyglucose positron emission tomography on the management of cutaneous malignant melanoma.Clin Nucl Med 2000;25:48–51.

    Article  PubMed  CAS  Google Scholar 

  29. Feun LG, Gutterman J, Burgess MA et al. The natural history of resectable metastatic melanoma (stage IVA melanoma).Cancer 1982;50:1656–63.

    Article  PubMed  CAS  Google Scholar 

  30. Overett TK, Shiu MH. Surgical treatment of distant metastatic melanoma. Indications and results.Cancer 1985;56:1222–30.

    Article  PubMed  CAS  Google Scholar 

  31. Hena MA, Emrich LJ, Nambisan RN, Karakousis CP. Effect of surgical treatment on stage IV melanoma.Am J Surg 1987;153:270–5.

    Article  PubMed  CAS  Google Scholar 

  32. Gadd MA, Coit DG. Recurrence patterns and outcome in 1019 patients underoing axillary of inguinal lymphadenectomy for melanoma.Arch Surg 1992;127:1412–6.

    PubMed  CAS  Google Scholar 

  33. Gorenstein LA, Putnam JB, Natarajan G, Balch CA, Roth JA. Improved survival after resection of pulmonary metastases from malignant melanoma.Ann Thorac Surg 1991;52:204–10.

    Article  PubMed  CAS  Google Scholar 

  34. Thayer JO Jr, Overholt RH. Metastatic melanoma to the lung: long-term results of surgical excision.Am J Surg 1985;149:558–62.

    Article  PubMed  Google Scholar 

  35. Pogrebniak HW, Stovroff M, Roth JA, Pass HI. Resection of pulmonary metastases from malignant melanoma: results of a 16-year experience.Ann Thorac Surg 1988;46:20–3.

    Article  PubMed  CAS  Google Scholar 

  36. Wong JH, Euhus DM, Morton DL. Surgical resection for metastatic melanoma to the lung.Arch Surg 1988;123:1091–5.

    PubMed  CAS  Google Scholar 

  37. Marincola FM, Mark JB. Selection factors resulting in improved survival after surgical resection of tumors metastatic to the lungs.Arch Surg 1990;125:1387–92.

    PubMed  CAS  Google Scholar 

  38. Karp NS, Boyd A, DePan HJ, Harris MN, Roses DF. Thoracotomy for metastatic malignant melanoma of the lung.Surgery 1990;107:256–61.

    PubMed  CAS  Google Scholar 

  39. Tafra L, Dale PS, Wanek LA, Ramming KP, Morton DL. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax.J Thorac Cardiovasc Surg 1995;110:119–28.

    Article  PubMed  CAS  Google Scholar 

  40. Webb WR, Gamsu G. Thoracic metastasis in malignant melanoma. A radiographic survey of 65 patients.Chest 1977;71:176–81.

    PubMed  CAS  Google Scholar 

  41. Quint LE, Park CH, Iannettoni MD. Solitary pulmonary nodules in patients with extrapulmonary neoplasm.Radiology 2000;217:257–61.

    PubMed  CAS  Google Scholar 

  42. Juttner FM, Smolle J, Pinter H, Popper H, Friehs G. Solitary coin lesion in patients with malignant melanoma: an indication for thoracotomy?Thorac Cardiovasc. Surg 1988;36:232–3.

    PubMed  CAS  Google Scholar 

  43. Johnson H Jr, Fantone J, Flye MW. Histological evaluation of the nodules resected in the treatment of pulmonary metastatic disease.J Surg Oncol 1982;21:1–4.

    Article  PubMed  Google Scholar 

  44. Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract.Surgery 1984;95:635–9.

    PubMed  CAS  Google Scholar 

  45. Das Gupta TK, Brasfield RD. Metastatic melanoma of the gastrointestinal tract.Arch Surg 1964;88:969–73.

    Google Scholar 

  46. Washington K, McDonagh D. Secondary tumors of the gastrointestinal tract: surgical pathologic findings and comparison with autopsy survey.Mod Pathol 1995;8:427–33.

    PubMed  CAS  Google Scholar 

  47. Ollila DW, Essner R, Wanek LA, Morton DL. Surgical resection for melanoma metastatic to the gastrointestinal tract.Arch Surg 1996;131:975–9.

    PubMed  CAS  Google Scholar 

  48. Ricaniadis N, Konstadoulakis MM, Walsh D, Karakousis CP. Gastrointestinal metastases from malignant melanoma.Surg Oncol 1995;4:105–10.

    Article  PubMed  CAS  Google Scholar 

  49. Khadra MH, Thompson JF, Milton GW, McCarthy WH. The justification for surgical treatment of metastatic melanoma of the gastrointestinal tract.Surg Gynecol Obstet 1990;171:413–6.

    PubMed  CAS  Google Scholar 

  50. Mendez IM, Del Maestro RF. Cerebral metastases from malignant melanoma.Can J Neurol Sci 1988;15:119–23.

    PubMed  CAS  Google Scholar 

  51. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases.Am J Surg 1978;135:807–10.

    Article  PubMed  CAS  Google Scholar 

  52. de la Monte SM, Moore GW, Hutchins GM. Patterned distribution of metastases from malignant melanoma in humans.Cancer Res 1983;43:3427–33.

    PubMed  Google Scholar 

  53. Wronski M, Aroll E. Surgical treatment of brain metestage from melanoma: a retrospective study of a patients.J. Neurosurg 2000; 93:9–18.

    PubMed  CAS  Google Scholar 

  54. Somaza S, Kondziolka D, Lunsford LD, Kirkwood JM. Flickinger JC. Stereotactic radiosurgery for cerebral metastatic melanoma.J Neurosurg 1993;79:661–6.

    Article  PubMed  CAS  Google Scholar 

  55. Lavine SD, Petrovich Z, Cohen-Gadol AA. et al. Gamma knife radiosurgery for metastatic melanoma: an analysis of survival, outcome, and complications.Neurosurgery 1999;44:59–64.

    Article  PubMed  CAS  Google Scholar 

  56. Mori Y, Kondziolka D, Flickinger JC, Kirkwood JM, Agarwala S, Lunsford LD. Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival.Int J Radiat Oncol Biol Phys 1998;42:581–9.

    Article  PubMed  CAS  Google Scholar 

  57. Seung SK, Sneed PK, McDermott MW et al. Gamma knife radiosurgery for malignant melanoma brain metastases.Cancer J Sci Am 1998;4:103–9.

    PubMed  CAS  Google Scholar 

  58. Brega K, Robinson WA, Winston K, Wittenberg W. Surgical treatment of brain metastases in malignant melanoma.Cancer 1990;66:2105–10.

    Article  PubMed  CAS  Google Scholar 

  59. Salvati M, Cervoni L, Caruso R, Gagliardi FM. Solitary cerebral metastasis from melanoma: value of the ‘en bloc’ resection.Clin Neurol Neurosurg 1996;98:12–4.

    Article  PubMed  CAS  Google Scholar 

  60. Branum GD, Epstein RE, Leight GS, Seigler HF. The role of resection in the management of melanoma metastatic to the adrenal gland.Surgery 1991;109:127–31.

    PubMed  CAS  Google Scholar 

  61. Haigh PI, Essner R, Wardlaw JC, Stern SL, Morton DL. Long-term survival after complete resection of melanoma metastatic to the adrenal gland.Ann Surg Oncol 1999;6:633–9.

    Article  PubMed  CAS  Google Scholar 

  62. Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis.Cancer 1998;82:389–94.

    Article  PubMed  CAS  Google Scholar 

  63. Rosario RT, DiMaio DJ, Lapham RL, Sweeney M, Smalling R, Barasch E. Metastatic ocular melanoma to the left ventricle inducing near-syncope attacks in an 84-year-old woman.Chest 2000; 118:551–3.

    Article  PubMed  CAS  Google Scholar 

  64. Gibbs P, Cebon JS, Calafiore P, Robinson WA. Cardiac metastases from malignant melanoma.Cancer 1999;85:78–84.

    Article  PubMed  CAS  Google Scholar 

  65. Gunduz K, Shields JA, Shields CL, Sato T, Mastrangelo MJ. Surgical removal of solitary hepatic metastasis from choroidal melanoma.Am J Ophthalmol 1998;125:407–9.

    Article  PubMed  CAS  Google Scholar 

  66. Mondragon-Sanchez R, Barrera-Franco JL, Cordoba-Gutierrez H, Meneses-Garcia A. Repeat hepatic resection for recurrent metastatic melanoma.Hepatogastroenterology 1999;46:459–61.

    PubMed  CAS  Google Scholar 

  67. Klaase JM, Kroon BB. Surgery for melanoma metastatic to the gastrointestinal tract.Br J Surg 1990;77:60–1.

    Article  PubMed  CAS  Google Scholar 

  68. Ihde JK, Coit DG. Melanoma metastatic to stomach, small bowel, or colon.Am J Surg 1991;162:208–11.

    Article  PubMed  CAS  Google Scholar 

  69. Caputy GG, Donohue JH, Goellner JR, Weaver AL. Metastatic melanoma of the gastrointestinal tract. Results of surgical management.Arch Surg 1991;126:1353–8.

    PubMed  CAS  Google Scholar 

  70. Hagen NA, Cirrincione C, Thaler HT, DeAngelis LM. The role of radiation therapy following resection of single brain metastasis from melanoma.Neurology 1990;40:158–60.

    PubMed  CAS  Google Scholar 

  71. Oredsson S, Ingvar C, Stromblad LG, Jonsson PE. Palliative surgery for brain metastases of malignant melanoma.Eur J Surg Oncol 1990;16:451–6.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastric & Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., 10021, New York, NY

    Peter J. Allen MD & Daniel G. Coit MD

Authors
  1. Peter J. Allen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel G. Coit MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel G. Coit MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Allen, P.J., Coit, D.G. The surgical management of metastatic melanoma. Annals of Surgical Oncology 9, 762–770 (2002). https://doi.org/10.1007/BF02574498

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02574498

Key Words

Search

Navigation