title: Metastasectomy for recurrent stage IV melanoma.
abstract: OBJECTIVE
  Many patients undergoing complete surgical resection of distant metastatic melanoma (American Joint Committee on Cancer [AJCC] stage IV) develop recurrent disease. We examined whether a second metastasectomy could prolong the survival of patients with recurrent stage IV melanoma.
  
  
  METHODS
  Retrospective review of our 8,750-patient melanoma database identified 211 patients who were rendered clinically free of disease by surgical resection of stage IV metastases during the 24-year study period (January 1971 through December 1995). Our study population comprised the 131 patients who developed recurrent stage IV disease and were followed for at least 24 months or until death.
  
  
  RESULTS
  The median disease-free interval prior to recurrent stage IV disease was 8 months (range 0.6-91.8 months). There were 131 tumor-involved anatomic sites; the median number was one (range 1-3). Of these sites, 71 (54.2%) were soft tissue, 35 (26.7%) were pulmonary, 28 (21.4%) were gastrointestinal, 23 (17.6%) were cerebral, 13 (9.9%) were skeletal, and 2 (1.5%) were gynecologic. Median survival following treatment for recurrent stage IV melanoma was 18.2 months after complete metastasectomy, compared with 12.5 months or 5.9 months after a palliative surgical procedure or nonsurgical management, respectively. The 5-year survival rate was 20.0% (8/40) for patients in the complete surgical metastasectomy group, compared with 7.0% (3/43) and 2.1% (1/48) for those in the palliative surgical and nonsurgical groups, respectively. By multivariate analysis, the two most important prognostic factors for survival following diagnosis of recurrent stage IV melanoma were a prolonged disease-free interval to recurrence (P = 0.0001) and complete surgical metastasectomy of the recurrence (P = 0.0001).
  
  
  CONCLUSIONS
  Metastasectomy can prolong the survival of patients with recurrent stage IV melanoma if all clinically evident tumor can be resected.
authors.affiliation: Roy E. Coats Research Laboratories and the Division of Surgical Oncology of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Ollila
authors.forename: E C
authors.initials: EC
authors.lastname: Hsueh
authors.forename: S L
authors.initials: SL
authors.lastname: Stern
authors.forename: D L
authors.initials: DL
authors.lastname: Morton
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D015996:Survival Rate