Surgical management of distant metastases

Patients who have metastatic melanoma have historically been treated with various systemic therapies with disappointing results. The newly revised American Joint Committee on Cancer staging system reflects that tumor biology must be considered when treating these patients. This article analyzes the various sites of melanoma metastases and presents data supporting a surgical approach to selected patients. A complete resection of metastatic disease to skin, soft tissue, distant lymph nodes, pulmonary, or other visceral sites offers the best chance for a prolonged survival. This article presents data supporting the repositioning of surgery in the treatment paradigm for metastatic melanoma.