Carbon dioxide laser ablation as first-line management of in-transit cutaneous malignant melanoma metastases

In-transit cutaneous malignant melanoma metastases remains a difficult and distressing disease. It is a sequela to the primary lesion represented by melanoma deposits between the site of excision and the draining lymph nodes. We present our experience of carbon dioxide ablation of in-transit cutaneous malignant melanoma metastases and discuss the role of laser ablation as first-line management of the disease. Using a departmental database and case notes, all patients who had undergone carbon dioxide laser ablation for malignant melanoma metastases in the authors' unit between December 1996 and December 2007 were reviewed. The total number of lesions ablated was 559 in 16 patients on 91 separate occasions. The mean number of lesions ablated at each treatment was 6 (range 4-200) and the mean number of treatments per patient was 5.7 (range 1-14). All patients had undergone previous surgical procedures for disease control (total 28, range 1-4). Ten patients remained clinically disease-free at 1-year follow-up. Of these ten patients. six achieved remission with a median time from first ablation of 7.5 years (range 2-10 years). Carbon dioxide laser ablation should be offered as first-line treatment in the management of cutaneous malignant melanoma metastases. A subgroup of patients were clinically disease-free with no systemic progression, following treatment, the reasons for which have not yet been fully explained.