Stage IV melanoma: completely resectable patients are scarce.

Abstract

In melanoma, about 1 in 5 patients develops distant metastases and suffers a very poor prognosis. Common treatment options comprise surgery, systemic medical therapy, and radiotherapy, depending on the number, the location, and the resectability of distant metastases. Previous studies suggested that surgery should be the first choice of treatment whenever complete surgical removal is feasible. However, the proportion of patients that are candidates for this approach is not clear. The aim of the present study was to evaluate the extent of disease and resectability in melanoma patients presenting with stage IV disease at our institute. All melanoma patients diagnosed with stage IV between January 2011 and August 2012 were assessed for extent and resectability of their disease. About half of 70 assessed patients had 7 or more metastases at diagnosis, whereas 13 patients had only 1 metastasis. The vast majority (n = 55, 78.6 %) was ineligible for complete surgical resection. Six patients did receive complete surgery as initial stage IV treatment and in 9 patients incomplete surgery was performed. Widespread disease (n = 44) and unresectable metastasis (n = 11) were the most common reasons for refraining from complete surgery. The results of the present study show that only a small proportion of patients diagnosed with stage IV melanoma are candidates for complete surgical resection with curative intent in our institution.