Time may Heal All Wounds, but While It Does, Melanoma Marches on

Excerpt

There have long been challenges in managing patients with stage III metastatic melanoma. Surgical resection as the initial therapy has been and remains the standard of care and the primary treatment for these patients; however, many of these patients will recur and some will have very rapid recurrence.1,2 In the absence of effective systemic therapy, this has been the reality for the surgeon caring for these patients, despite knowing that some stage III metastatic melanoma patients are unlikely to benefit from aggressive surgical management. The study by Bloemendal et al.3 highlights this problem and seeks to characterize a group of patients at greatest risk for early recurrence. The authors present a group of 120 patients with stage IIIb (58%) and IIIc (43%) melanoma completely resected surgically and then screened within 10 weeks of surgery for inclusion in an adjuvant therapy trial. Of these patients, 18% were found to have new disease not identified preoperatively, the majority of whom were asymptomatic. While most patients (83%) screened for their adjuvant therapy trial had macroscopic nodal disease, an even greater proportion (91%) with an early recurrence did, suggesting this clinicopathologic feature in particular may be a primary risk factor. Other common characteristics did not appear to be different between the groups. As the authors point out, these findings underscore the need to closely evaluate patients eligible for adjuvant trials to assure they do not have unsuspected disease prior to initiating therapy. In addition, these results highlight the significant risk of recurrence in this population, the challenge in managing them surgically, and the critical importance of multimodality therapy in improving outcomes. …