Surgical therapy for distant metastases of malignant melanoma

BACKGROUND. Manifestation of distant metastases in melanoma patients common ly indicates a poor prognosis. The aim of the current study was to examine the role of surgical treatment in these patients. METHODS, Data from 444 patients with distant melanoma metastases were gathe red prospectively from January 1978 through December 1997. Characteristics of the primary tumor, time until the first occurrence of distant metastases , frequency and site of distant metastases, surgical therapy, and survival were evaluated by univariate and multivariate analyses. RESULTS. Histology, Breslow thickness, Clark level, and pT and pN categorie s (UICC 1997) significantly influenced the median interval from initial dia gnosis to manifestation of distant metastases. The most common single local ization was the lung (n = 83), followed by distant lymph node (n = 79), and skin metastases (n = 51). One hundred seventy-four patients received surgi cal treatment (39%) and 111 (25%) patients received surgical treatment with curative resection (RO, UICC 1997), most frequently in distant lymph node or skin metastases (57% and 59%, respectively). Median survival time and 2- year survival rate for all patients were 7 months and 15.8%, respectively, 17 months and 36.1% following curative resection, 6 months and 12.7% after incomplete resection (n = 63) (P < 0.0001). Conservatively treated patients survived for a median of only 4 months with a 2-year survival of 8.1%. Mul tivariate survival analysis showed localization of the primary tumor (head/ neck/trunk vs. extremities), the number of involved sites, and surgical the rapy to be independent prognostic factors. CONCLUSIONS. Surgical therapy of distant metastases was most beneficial whe n complete removal of metastatic tissue was achieved. Selection of patients for surgical excision should be determined by individual patient indicatio ns. (C) 2000 American Cancer Society.