Role of surgery in patients with stage IV melanoma.
OBJECTIVE
The purpose of this brief review is to highlight recent advances in the surgical treatment of metastatic melanoma; to review factors important in the decision-making process of selecting the most appropriate patients for resection; and to discuss the current literature in the context of site of recurrence.


RESULTS
While there are relatively few new findings on the surgical treatment of metastatic melanoma, recent reports do support prior observations in the field. The recently revised staging system for melanoma groups metastatic disease according to prognostic features. There is currently a great deal of interest in the use of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) to more accurately evaluate metastatic disease. The use stereotactic radiosurgery for brain metastases has expanded recently and adds to local treatment options. When procedures are performed with palliative intent, treatment goals must be clearly defined and communicated among the patient, family and surgeon. Improved understanding of the goals of palliative surgery may be facilitated by the concept of a palliative triangle, which helps define the decision making process among the patient, family members, and surgeon.


CONCLUSIONS
Metastatic melanoma is usually associated with a dismal prognosis. When a procedure is performed with palliative intent, appropriately selected patients usually experience reliable relief of symptoms and improved quality of life. Improved survival after a complete resection with curative intent is often predicted by good performance status, longer disease-free interval, limited extent of metastatic disease, and less aggressive tumor biology.
Wong
Sandra L
SL
Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. coitd@mskcc.org
Coit
Daniel G
DG
D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D003657:Decision Making; D019788:Fluorodeoxyglucose F18; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D009367:Neoplasm Staging; D010166:Palliative Care; D011859:Radiography; D019275:Radiopharmaceuticals; D012307:Risk Factors; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18