Surgical and Systemic Approaches in Metastatic Melanoma

Metastatic melanoma has historically carried a poor prognosis, but advances in both surgical techniques and systemic therapies have reshaped its management. Surgical intervention remains an integral option for selected patients, particularly those with limited metastatic burden, or oligometastatic disease, where complete resection of nodal, pulmonary or visceral lesions can prolong survival and maintain quality of life. Minimally invasive approaches and stereotactic body radiotherapy allow accurate local control with minimal morbidity. Parallel to these developments, systemic therapies including immune checkpoint inhibitors targeting CTLA-4 and PD-1, as well as targeted agents against the BRAF and MEK pathways, have transformed overall outcomes. These agents can induce durable responses, yet resistance and progression often occur, necessitating combined or sequential treatment modalities. Contemporary care emphasises multidisciplinary assessment to tailor strategies that integrate surgery, radiotherapy and systemic regimens. Patient selection is guided by factors such as disease-free interval, growth pattern, molecular profile and performance status, reflecting a personalised medicine approach. This integrative paradigm underpins ongoing efforts to optimise long-term disease control and to translate emerging scientific insights into clinical benefit.

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Surgical and Systemic Approaches in Metastatic Melanoma publication trend

The graph below shows the total number of articles in surgical and systemic approaches in metastatic melanoma across all publications each year (not limited to Nature Index journals).

Technical terms

Oligometastatic disease: A state in which cancer has spread to a limited number of sites, often defined as up to three to five lesions, amenable to local therapy.

Metastasectomy: Surgical removal of metastatic tumour deposits aimed at achieving complete resection and potential long-term control.

Immune checkpoint inhibitor: A class of drugs that block inhibitory pathways such as CTLA-4 or PD-1 to enhance T-cell-mediated antitumour immunity.

Stereotactic body radiotherapy (SBRT): A precise form of high-dose radiotherapy delivered in a few fractions to target lesions while minimising exposure to surrounding tissues.

Progression-free survival (PFS): The length of time during and after treatment in which a patient’s disease does not worsen.

References

1. Surgical Resection of Pulmonary Metastases from Melanoma in Oligometastatic Patients: Results from a Multicentric Study in the Era of Immunoncology and Targeted Therapy. Cancers (2023).
2. Surgery for Unresectable Stage IIIC and IV Melanoma in the Era of New Systemic Therapy. Cancers (2020).
3. The Role of Stereotactic Radiotherapy in the Management of Melanoma, A Retrospective Single Institute Preliminary Study of 30 Patients. Pathology & Oncology Research (2022).