How is stage IV of melanoma treated?

Updated: Mar 08, 2019
  • Author: Jonathan B Heistein, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

Answer

Advanced metastatic melanoma is usually refractory to standard therapy; thus, consider these patients for clinical trials. Some treatments have yielded various objective responses, although they are usually short-lived. Dacarbazine (DTIC) and the nitrosoureas, carmustine (BCNU) and lomustine (CCNU), produced a 20% objective response rate. Response rates for interferon alfa and interleukin 2 range from 8-22% and 10-20%, respectively. Recently, 2 studies have shown promising results. One study showed improved rates of overall and progression-free survival in patients with previously untreated metastatic melanoma with the BRAF V600E mutation who received vemurafenib versus standard dacarbazine. [26] Another trial showed improved survival for metastatic melanoma patients treated with ipilimumab and dacarbazine versus placebo and dacarbazine. [27]

Another study looking at treatment of advanced extremity melanoma showed that hyperthermic isolated limb perfusion therapy is a more effective way of controlling this type of situation than isolated limb infusion therapy. [28] Currently, other studies in progress are comparing other cytotoxic and biologic drug regimens.

Surgical resection of isolated metastases in the gastrointestinal tract, the brain, the lungs, or bone may be performed for palliation, with occasional long survival. Metastatic lymph nodes also may be removed for palliation. Radiation may provide symptomatic relief for metastases to bone, the brain, or viscera. In-transit metastases arise in the lymphatics or soft tissue between the primary lesion and the regional lymph node basin at a rate of 2-3%. In addition to wide surgical excision as for a primary lesion, isolated hyperthermic limb perfusion is probably the most effective treatment for extremity lesions. Radiation and intralesional BCG vaccine injections have had varied success.


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