Surgery for Metastatic Melanoma: an Evolving Concept
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Purpose of Review
This review describes the evolving role of surgery in stage III and IV melanoma.
Surgery has been the first option to cure melanoma patients at initial diagnosis of metastatic spread: a complete surgical excision of the disease either in stage III or IV has been the gold standard for decades. A positive sentinel node biopsy (SNB) has been followed by a complete lymph node dissection (CLND) since the early stages of modern surgical oncology. However, since two randomized trials have indicated that a CLND does not improve survival in patients with a positive SNB, a CLND is no longer considered mandatory. A therapeutic lymph node dissection (TLND) is still offered to patients with macroscopic nodal disease and in highly selected cases, patients with distant melanoma metastases can be treated surgically as well. Also the availability of adjuvant, and in the future possibly neoadjuvant, systemic therapy have shifted the landscape to less extensive surgery in metastatic melanoma.
With the development of new systemic options, surgery in metastatic melanoma has become more and more part of a multidisciplinary treatment: surgical indications are moving from previous standards to a new role.
KeywordsMelanoma surgery Sentinel node biopsy Lymph node dissection
Compliance with Ethical Standards
Conflict of Interest
Alessandro A.E. Testori declares that he has no conflict of interest.
Stephanie A. Blankenstein declares that she has no conflict of interest.
Alexander C.J. van Akkooi is supported by research funding from Amgen, Bristol-Myers Squibb, and Novartis; and has served as a consultant for and has participated on advisory boards sponsored by Amgen, Bristol-Myers Squibb, Novartis, MSD-Merck, Merck-Pfizer, and 4SC. All were unrelated to this work and all funds paid to his institution.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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