Surgical treatment of metastatic melanoma

BACKGROUND: The survival of patients with metastatic melanoma is poor. The response rates for chemotherapy and immunotherapy have been low, with no real improvement in survival. We reviewed the results of surgical resection. METHODS: We performed a retrospective review of the medical records of all patients who underwent resection of metastases from melanoma from 1979 to 1994. RESULTS: There were 77 patients (44 men, 33 women, mean age 51 years). Metastases were resected from soft tissue (n = 28), abdominal viscera (n = 22), lung (n = 15), and brain (n = 12). Forty-four patients had complete resections, and 33 had incomplete resections. Sixty-five patients had solitary lesions and 12 had multiple lesions resected. The overall 5-year survival rate was 10%. Patients with solitary lesions had a 5-year survival rate of 12%, compared with 0% for patients with multiple lesions (P = 0.01). Patients with complete resection had a 5-year survival rate of 15%, compared with 4% for patients with incomplete resection (P < 0.001). Patients with complete resection of solitary lesions had a 5-year survival of 18%. There was no difference in survival between synchronous and metachronous resection. Gender, primary site, disease-free interval, and metastatic site had no impact on survival rates. CONCLUSIONS: We conclude that patients with metastatic melanoma should be resected for (1) relief of symptoms such as obstruction and bleeding, (2) solitary lesions that can be completely resected, (3) serial lesions that can be completely resected, and (4) selected cases that can be rendered macroscopically free of disease. Surgical resection is superior to any other available therapy for metastatic melanoma.