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 surgi cal resection, METHODS: We performed a retrospective review of the med ical records of all patients who underwent resection of metastases fro m melanoma from 1979 to 1994, RESULTS: There were 77 patients (44 men, 33 women, mean age 51 years). Metastases were resected from soft tiss ue (n = 28), abdominal viscera (n = 22), lung (n = 15), and brain (n = 12). Forty-four patients had complete resections, and 33 had incomple te resections. Sixty-five patients had solitary lesions and 12 had mul tiple lesions resected, The overall 5-year survival rate was 10%, Pati ents 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 com plete resection of solitary lesions had a 5-year survival of 18%, Ther e was no difference in survival between synchronous and metachronous r esection, Gender, primary site, disease-free interval, and metastatic site had no impact on survival rates. CONCLUSION: We conclude that pat ients with metastatic melanoma should be resected for (1) relief of sy mptoms such as obstruction and breeding, (2) solitary lesions that can be completely resected, (3) serial lesions that can be completely res ected, and (4) selected cases that can be rendered macroscopically fre e of disease. Surgical resection is superior to any other available th erapy for metastatic melanoma, (C) 1998 by Excerpta Medica, Inc.