Surgical management of melanoma

Surgical therapy is mainly indicated in stage III disease, whereas systemic medical treatment now plays a key role in stage IV melanoma.

Prof. John Kelly (The Alfred Hospital, Australia) stated that surgery for melanoma has changed [1]. Sentinel lymph node biopsy (SLNB) is still indicated in all melanomas equal to or greater than 1 mm. However, its predictive value is limited given that 62% and 48% of patients with intermediate or thick melanomas, respectively, who have positive results will still be alive at 10 years. On the other hand, 35% of patients with thick tumours will die within 10 years after a negative result [2].

Surgery remains the standard of care for clinically evident stage III disease, also after neoadjuvant treatment. In stage IV, surgery is only indicated in easily resectable or imminently threatening meSkin lanoma, because stage IV is now the mainstay of systemic therapy. Surgery is used initially for brain metastases. In addition, it can be a valuable option for patients progressing during immune or targeted therapy.

1. 
   
   1. Kelly J. 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.
   2. Grob JJ. Melanoma Letter 2015.

Posted on 26 August, 201921 March, 2021