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Surgical management of metastatic melanoma

Michael Stone, MD
Section Editors
Michael B Atkins, MD
Russell S Berman, MD
Deputy Editor
Michael E Ross, MD


Although the incidence of malignant melanoma is increasing, most cases are diagnosed at an early stage. Surgical excision is curative in most cases of early stage disease, and patients at high risk of developing metastatic disease may benefit from adjuvant therapy with interferon alpha or ipilimumab. (See "Initial surgical management of melanoma of the skin and unusual sites" and "Adjuvant immunotherapy for melanoma".)

The management of patients with disseminated disease is a difficult problem. Systemic approaches that have been shown to provide clinically important benefit for appropriately selected patients with disseminated melanoma include immunotherapy with high-dose interleukin-2 (IL-2), immunotherapy with checkpoint inhibitors directed against CTLA-4 and programmed death 1 protein (PD1), and inhibition of the MAP kinase pathway with a BRAF and MEK inhibitors in patients whose tumors contain a V600 mutation in the BRAF gene.

The role of surgery in the treatment of metastatic disease is discussed in this topic. An overview of the management of advanced melanoma is presented separately. (See "Overview of the management of advanced cutaneous melanoma".)


Patients who have limited sites of metastatic disease may be amenable to surgical resection. Complete surgical excision of limited metastatic disease can result in prolonged overall and occasionally relapse-free survival in carefully selected patients. Surgery for distant metastatic melanoma, however, is rarely curative since the majority of patients with distant metastases have widespread micrometastatic disease even if clinical and imaging criteria suggest limited spread. Resection should be reserved for the relief or prevention of morbidity due to local tumor growth and for patients in whom a longer survival might be expected with surgical rather than medical treatment.

When surgery is considered, careful patient selection is important and treatment must be individualized. Factors to be considered include the severity of symptoms, pace of disease progression, previous treatment and treatment response, patient age and medical condition, and the desires of the patient. Quality of life should be the principal goal of treatment for many patients.


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Literature review current through: Sep 2016. | This topic last updated: Sep 8, 2016.
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  1. Sosman JA, Moon J, Tuthill RJ, et al. A phase 2 trial of complete resection for stage IV melanoma: results of Southwest Oncology Group Clinical Trial S9430. Cancer 2011; 117:4740.
  2. Hsueh EC, Essner R, Foshag LJ, et al. Prolonged survival after complete resection of disseminated melanoma and active immunotherapy with a therapeutic cancer vaccine. J Clin Oncol 2002; 20:4549.
  3. Yang JC, Abad J, Sherry R. Treatment of oligometastases after successful immunotherapy. Semin Radiat Oncol 2006; 16:131.
  4. Karakousis CP, Velez A, Driscoll DL, Takita H. Metastasectomy in malignant melanoma. Surgery 1994; 115:295.
  5. Hughes TM, A'Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg 2000; 87:892.
  6. Mann GB, Coit DG. Does the extent of operation influence the prognosis in patients with melanoma metastatic to inguinal nodes? Ann Surg Oncol 1999; 6:263.
  7. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 1978; 135:807.
  9. Budman DR, Camacho E, Wittes RE. The current causes of death in patients with malignant melanoma. Eur J Cancer 1978; 14:327.
  10. Leo F, Cagini L, Rocmans P, et al. Lung metastases from melanoma: when is surgical treatment warranted? Br J Cancer 2000; 83:569.
  11. Petersen RP, Hanish SI, Haney JC, et al. Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma. J Thorac Cardiovasc Surg 2007; 133:104.
  12. Sampson JH, Carter JH Jr, Friedman AH, Seigler HF. Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg 1998; 88:11.
  13. Branum GD, Seigler HF. Role of surgical intervention in the management of intestinal metastases from malignant melanoma. Am J Surg 1991; 162:428.
  14. Gutman H, Hess KR, Kokotsakis JA, et al. Surgery for abdominal metastases of cutaneous melanoma. World J Surg 2001; 25:750.
  15. Agrawal S, Yao TJ, Coit DG. Surgery for melanoma metastatic to the gastrointestinal tract. Ann Surg Oncol 1999; 6:336.
  16. Krige JE, Nel PN, Hudson DA. Surgical treatment of metastatic melanoma of the small bowel. Am Surg 1996; 62:658.
  17. Caputy GG, Donohue JH, Goellner JR, Weaver AL. Metastatic melanoma of the gastrointestinal tract. Results of surgical management. Arch Surg 1991; 126:1353.
  18. Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976) 1999; 24:2240.
  19. Pawlik TM, Zorzi D, Abdalla EK, et al. Hepatic resection for metastatic melanoma: distinct patterns of recurrence and prognosis for ocular versus cutaneous disease. Ann Surg Oncol 2006; 13:712.
  20. Aubin JM, Rekman J, Vandenbroucke-Menu F, et al. Systematic review and meta-analysis of liver resection for metastatic melanoma. Br J Surg 2013; 100:1138.
  21. Branum GD, Epstein RE, Leight GS, Seigler HF. The role of resection in the management of melanoma metastatic to the adrenal gland. Surgery 1991; 109:127.
  22. Haigh PI, Essner R, Wardlaw JC, et al. Long-term survival after complete resection of melanoma metastatic to the adrenal gland. Ann Surg Oncol 1999; 6:633.
  23. Strong VE, D'Angelica M, Tang L, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol 2007; 14:3392.
  24. Ollila DW, Hsueh EC, Stern SL, Morton DL. Metastasectomy for recurrent stage IV melanoma. J Surg Oncol 1999; 71:209.