Lung metastases from melanoma: when is surgical treatment warranted?

Surgical treatment of lung metastases from melanoma is highly controversial as the expected outcome is much poorer than for other primary tumours and a reliable system for selecting patients is lacking. This study evaluated t he long-term results of lung metastasectomy for melanoma, with the aim of d efining a subset of patients with better prognosis. By reviewing the data o f the International Registry of Lung Metastases (IRLM), we identified 328 p atients who underwent lung metastasectomy for melanoma in the period 1945-1 995. Survival was calculated by Kaplan-Meier estimate, using log-rank test and Cox regression model for statistical analysis. After complete pulmonary metastasectomy (282 patients) the 5- and 10-year survival was 22% and 16%, respectively. In this group of patients, a time to pulmonary metastases (T PM) shorter than 36 months or the presence of multiple metastases were inde pendent unfavourable prognostic factors. There were no long-term survivors after incomplete resection (46 patients, P < 0.01). Using the IRLM grouping system, patients without risk factors (TPM > 36 months and single lesion) experienced the best survival (29% at 5 years), followed by those with one risk factor only (20% at 5 years). On the other hand, those with two risk f actors or incomplete resection showed a significantly poorer survival (7% a nd 0% at 5 years). Surgery plays an important role in carefully selected ca ses of pulmonary metastatic melanoma. The prognostic grouping system propos ed by the International Registry of Lung Metastases provides a simple and e ffective method for improving the selection of surgical candidates. (C) 200 0 Cancer Research Campaign.