Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 2000 Aug 16;83(5):569–572. doi: 10.1054/bjoc.2000.1335

Lung metastases from melanoma: when is surgical treatment warranted?

F Leo 1, L Cagini 2, P Rocmans 3, M Cappello 3, A N Van Geel 4, G Maggi 5, P Goldstraw 6, U Pastorino 1
PMCID: PMC2363508  PMID: 10944593

Abstract

Surgical treatment of lung metastases from melanoma is highly controversial as the expected outcome is much poorer than for other primary tumours and a reliable system for selecting patients is lacking. This study evaluated the long-term results of lung metastasectomy for melanoma, with the aim of defining a subset of patients with better prognosis. By reviewing the data of the International Registry of Lung Metastases (IRLM), we identified 328 patients who underwent lung metastasectomy for melanoma in the period 1945–1995. Survival was calculated by Kaplan–Meier estimate, using log-rank test and Cox regression model for statistical analysis. After complete pulmonary metastasectomy (282 patients) the 5- and 10-year survival was 22% and 16%, respectively. In this group of patients, a time to pulmonary metastases (TPM) shorter than 36 months or the presence of multiple metastases were independent unfavourable prognostic factors. There were no long-term survivors after incomplete resection (46 patients, P< 0.01). Using the IRLM grouping system, patients without risk factors (TPM > 36 months and single lesion) experienced the best survival (29% at 5 years), followed by those with one risk factor only (20% at 5 years). On the other hand, those with two risk factors or incomplete resection showed a significantly poorer survival (7% and 0% at 5 years). Surgery plays an important role in carefully selected cases of pulmonary metastatic melanoma. The prognostic grouping system proposed by the International Registry of Lung Metastases provides a simple and effective method for improving the selection of surgical candidates. © 2000 Cancer Research Campaign

Keywords: pulmonary metastatic melanoma, metastasectomy

Full Text

The Full Text of this article is available as a PDF (57.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cahan W. G. Excision of melanoma metastases to lung: problems in diagnosis and management. Ann Surg. 1973 Dec;178(6):703–709. doi: 10.1097/00000658-197312000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Falkson C. I., Ibrahim J., Kirkwood J. M., Coates A. S., Atkins M. B., Blum R. H. Phase III trial of dacarbazine versus dacarbazine with interferon alpha-2b versus dacarbazine with tamoxifen versus dacarbazine with interferon alpha-2b and tamoxifen in patients with metastatic malignant melanoma: an Eastern Cooperative Oncology Group study. J Clin Oncol. 1998 May;16(5):1743–1751. doi: 10.1200/JCO.1998.16.5.1743. [DOI] [PubMed] [Google Scholar]
  3. Fletcher W. S., Pommier R. F., Lum S., Wilmarth T. J. Surgical treatment of metastatic melanoma. Am J Surg. 1998 May;175(5):413–417. doi: 10.1016/S0002-9610(98)00041-5. [DOI] [PubMed] [Google Scholar]
  4. Gorenstein L. A., Putnam J. B., Natarajan G., Balch C. A., Roth J. A. Improved survival after resection of pulmonary metastases from malignant melanoma. Ann Thorac Surg. 1991 Aug;52(2):204–210. doi: 10.1016/0003-4975(91)91337-u. [DOI] [PubMed] [Google Scholar]
  5. Harpole D. H., Jr, Johnson C. M., Wolfe W. G., George S. L., Seigler H. F. Analysis of 945 cases of pulmonary metastatic melanoma. J Thorac Cardiovasc Surg. 1992 Apr;103(4):743–750. [PubMed] [Google Scholar]
  6. Holder W. D., Jr, White R. L., Jr, Zuger J. H., Easton E. J., Jr, Greene F. L. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg. 1998 May;227(5):764–771. doi: 10.1097/00000658-199805000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Karakousis C. P., Velez A., Driscoll D. L., Takita H. Metastasectomy in malignant melanoma. Surgery. 1994 Mar;115(3):295–302. [PubMed] [Google Scholar]
  8. Mathisen D. J., Flye M. W., Peabody J. The role of thoracotomy in the management of pulmonary metastases from malignant melanoma. Ann Thorac Surg. 1979 Apr;27(4):295–299. doi: 10.1016/s0003-4975(10)63302-4. [DOI] [PubMed] [Google Scholar]
  9. Mountain C. F., McMurtrey M. J., Hermes K. E. Surgery for pulmonary metastasis: a 20-year experience. Ann Thorac Surg. 1984 Oct;38(4):323–330. doi: 10.1016/s0003-4975(10)62280-1. [DOI] [PubMed] [Google Scholar]
  10. Ollila D. W., Stern S. L., Morton D. L. Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma. J Surg Oncol. 1998 Dec;69(4):206–211. doi: 10.1002/(sici)1096-9098(199812)69:4<206::aid-jso3>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  11. Pogrebniak H. W., Stovroff M., Roth J. A., Pass H. I. Resection of pulmonary metastases from malignant melanoma: results of a 16-year experience. Ann Thorac Surg. 1988 Jul;46(1):20–23. doi: 10.1016/s0003-4975(10)65845-6. [DOI] [PubMed] [Google Scholar]
  12. Slingluff C. L., Jr, Dodge R. K., Stanley W. E., Seigler H. F. The annual risk of melanoma progression. Implications for the concept of cure. Cancer. 1992 Oct 1;70(7):1917–1927. doi: 10.1002/1097-0142(19921001)70:7<1917::aid-cncr2820700719>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  13. Tafra L., Dale P. S., Wanek L. A., Ramming K. P., Morton D. L. Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax. J Thorac Cardiovasc Surg. 1995 Jul;110(1):119–129. doi: 10.1016/S0022-5223(05)80017-0. [DOI] [PubMed] [Google Scholar]
  14. Thayer J. O., Jr, Overholt R. H. Metastatic melanoma to the lung: long-term results of surgical excision. Am J Surg. 1985 Apr;149(4):558–562. doi: 10.1016/s0002-9610(85)80056-8. [DOI] [PubMed] [Google Scholar]
  15. Wong J. H., Skinner K. A., Kim K. A., Foshag L. J., Morton D. L. The role of surgery in the treatment of nonregionally recurrent melanoma. Surgery. 1993 Apr;113(4):389–394. [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES