title: Surgery and adjuvant therapies in the treatment of stage IV melanoma: our experience in 84 patients.
abstract: OBJECTIVE
  Survival rates of patients with stage IV melanoma are poor: Median survival is 7-8 months and 5-year survival rates about 5%. There is no agreement on the role of surgery at this stage. Most patients with metastatic melanoma are not able to undergo resection and usually are sent to systemic chemo- and immunotherapy.
  
  
  METHODS
  Eighty-four patients operated on for stage IV melanoma were evaluated. Of them, 61.9% were submitted to reiterative surgery with 168 operations and 182 surgical procedures overall. A total of 90.5% was submitted to adjuvant therapies according to aggressive and reiterated schedules: chemotherapy, immunotherapy, dendritic cells vaccine, infusion of tumor infiltrating lymphocytes, local therapies as electrochemotherapy.
  
  
  RESULTS
  The mean overall survival (Kaplan-Meier) was 56.7 months (1 year: 72.1%, 3 years: 46.5%, 5 years: 23.16%). The survival of reiterative surgery was significatively longer than single surgery (62.7 vs 42.4 months, median 50.9 vs 16.0), p = 0.03. Multivariated Cox analysis was performed for disease-free interval, repeated surgery, adjuvant therapies, and site of metastasis according to the American Joint Committee on Cancer: Reiterative surgery was shown as an independent prognostic factor (p < 0.05).
  
  
  CONCLUSIONS
  Metastatic resection associated with adjuvant therapy may improve overall survival and, in some instances, can provide long-term survival, whatever site and numbers of metastasis. In our series, reiterative surgery was more significatively efficient in improving survival than single-time surgery.
authors.affiliation: Institute of Clinical Surgery, University of Trieste, Trieste, Italy. ftauceri@gmail.com
authors.forename: Francesca
authors.initials: F
authors.lastname: Tauceri
authors.forename: Gianni
authors.initials: G
authors.lastname: Mura
authors.forename: Mauro
authors.initials: M
authors.lastname: Roseano
authors.forename: Massimo
authors.initials: M
authors.lastname: Framarini
authors.forename: Laura
authors.initials: L
authors.lastname: Ridolfi
authors.forename: Giorgio M
authors.initials: GM
authors.lastname: Verdecchia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult