Table 5. Treatment Modalities for Melanoma Metastases.
| Metastases localization, number (pathological stage) | Treatment modalities | Grade of recommendation |
|---|---|---|
| Painful bone metastases (pTxNxM1a-1c) | Radiotherapy | B |
| Bone-modifying agents | C | |
| Consider clinical trial participation | ||
| Multiple metastases (pTxNxM1a-1c) | Systemic therapy | A |
| Consider clinical trial participation | ||
| Solitary lung, liver, kidney and other metastases (pTxNxM1) | Systemic therapy | A |
| Surgical removal | C | |
| Stereotactic irradiation | C | |
| Consider clinical trial participation | ||
| Solitary CNS metastases (pTxNxM3) | Stereotactic irradiation | B |
| Systemic treatment | B | |
| Neurosurgical removal | C | |
| Consider clinical trial participation | ||
| Locoregional LNs (pTxN1bN2b, N2c, 3) | Complete surgical removal followed by adjuvant therapy | A |
| Irradiation in case of incomplete resection | C | |
| Consider trial participation | ||
| Loco regional LNs (pTxN1a, 2a, N3a) | Consider adjuvant therapy | A |
| Consider trial participation | B | |
| Multiple ITMs (> 5; pTXN2cM0) | T-VEC | B |
| Systemic therapy | C | |
| Perfusion of the extremity | C | |
| Electro chemotherapy | D | |
| Few ITMs (pTXN2cM0) | Surgical removal | C |
| T-VEC | C | |
| Irradiation, electrochemotherapy | D |
CNS: central nervous system; LNs: lymph nodes; ITMs: in-transit metastases; T-VEC: talimogene laherparepvec.