Evolving treatment of locoregional metastatic melanoma

Abstract

In melanoma patients, lymph node metastases are one of the most important predictors of survival. Lymph node dissection used to be standard treatment after a positive SLNB and still is standard surgical therapy in case of clinically palpable lymph nodes. Inguinal lymph node dissections(ILNDs) have a high rate of postoperative wound complications. Changes in the perioperative care around ILNDs in the UMCG have not led to a decrease in wound complications. Limiting the extent of the dissection in hope to decrease these complications, by determining pelvic nodal involvement prior to the dissection is not possible yet, as the available predictors are not accurate enough. At the UMCG a new surgical procedure (videoscopic inguinofemoral lymph node dissection) was introduced to limit the number of postoperative surgical complications. This might be a promising method to reduce wound complications after ILNDs, as it has a comparable complication rate and a good oncologic outcome. When lymph node metastases are deemed inoperable, patients used to be deemed palliative. And no operation was performed. Since the introduction of new systemic therapies, surgery can be preceded or followed by systemic therapy. This systemic treatment can be used to reduce tumor size, paving the way for a surgical resection. In patients with unfavorable tumor characteristics such as nodular ulcerated melanoma, adjuvant systemic therapy trials should be considered. Since the introduction of new systemic therapies, the surgical treatment of metastatic melanoma has changed and multidisciplinary approach is needed.