What is the prognosis of stage IV cutaneous melanoma?

Updated: Oct 13, 2020
  • Author: Susan M Swetter, MD; Chief Editor: Dirk M Elston, MD  more...
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Prior to the advent of checkpoint inhibitors and targeted therapy for melanoma, prognosis for distant metastatic disease was extremely poor, with median survival of only 6-9 months and 5-year survival rates of less than 20%, depending on the site(s) of metastasis. In general, patients with soft tissue, nodal, and isolated lung metastases have had slightly better prognoses than those with other visceral metastases and/or elevated LDH levels. With immune checkpoint blockade or targeted therapy, high overall response rates and disease control has become the norm in patients with unresectable stage III and IV melanoma. Durable complete responses have been observed, particularly with novel immunotherapies. Gene profiling is emerging as a valuable modality to assess prognosis and influence treatment decisions. [26, 27, 28, 29, 30, 31, 32, 33, 34]

Systemic chemotherapy is no longer the mainstay of treatment for metastatic melanoma; it is associated with low response rates (< 20%), which also tend to be of short duration.

Biochemotherapy, using standard chemotherapeutic agents with biologic response modifiers such as IL-2, IFN alfa, or granulocyte macrophage colony-stimulating factor, has shown limited success in the management of unresectable stage IV melanoma and no OS benefit or durable responses in patients with metastatic disease. [35] High-dose IL-2 alone, or combined with histamine dihydrochloride, has resulted in durable remission in a very small subset of patients with advanced disease, but is characterized by significant toxicity and need for hospitalization and careful monitoring during drug administration. [36]

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