Surgery for Metastatic Melanoma: an Evolving Concept

Alessandro A.E. Testori, Stephanie A. Blankenstein, Alexander C.J. van Akkooi

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: This review describes the evolving role of surgery in stage III and IV melanoma. Recent Findings: 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. Summary: 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.

Original languageEnglish
Article number98
JournalCurrent Oncology Reports
Volume21
Issue number11
DOIs
Publication statusPublished - Nov 1 2019

Keywords

  • Lymph node dissection
  • Melanoma surgery
  • Sentinel node biopsy

ASJC Scopus subject areas

  • Oncology

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