SUCCESSFUL RESECTION OF SOLITARY LIVER ME TASTASES OF MELANOMA

Patients with solitary metastasis of melanoma may benefit from resecti on, although diffuse organ involvement is common. Recent results in im munotherapy of metastatic melanoma are impaired by early local recurre nce, leading to consolidation surgery. Two patients with solitary live r metastasis were treated by liver resection. In one patient in Januar y 1993, atypical resection was performed after partial remission induc ed by regional adoptive immunotherapy with LAK-cells and Interleukin-2 . In September 1983 right hemihepatectomy was done in one patient for large metastasis without preceding therapy. Until now there is no evid ence of disease in both patients. The metastasis were 14 cm without an d 3.5 cm after (5.3 cm before) immunotherapy in diameter. On histologi c examination we found only a slight necrosis without marked immunolog ical reaction like mononuclear cell infiltration or fibrotic demarcati on in the specimen of the patient without forgoing therapy. In the spe cimen of the patient after immunotherapy, the metastasis was necrotic. It was encapsulated by fibrous tissue which was infiltrated by lympho id cells. The microscopic evaluation revealed some clots of vital tumo rcells. The resection of solitary liver metastasis of melanoma with or without immunotherapy is recommended. The rational for consolidation surgery for melanoma metastases after successful immunotherapy is base d on the histologically proven vital tumor cells in necrotic metastasi s, which are responsible for early local recurrence.