Does metastasectomy improve survival in skeletal melanoma?

Melanoma metastatic to bone carries a poor prognosis with overall median survival in the 4-6 months range. Others have published data that suggest resection of isolated visceral organ metastases improves survival. We conducted a retrospective analysis of 130 cases of stage IV melanoma with pathologically confirmed bony disease. We used Cox regression survival analysis to compare a group of patients who underwent wide resection of metastases with those who received other surgery or were treated nonoperatively. We also compared the three groups against matched historical stage IV melanoma controls to determine differences between expected and observed 1-year overall survival. Median overall survival for the nonoperative (N=80), intralesional (N=32), and resection (N=18) groups was 4.8, 5.1, and 11.8 months, respectively. Cox regression survival analysis confirmed the overall survival benefit resulting from wide resection (hazard ratio 0.53) after correcting for independent predictors of worse survival, such as pathologic spinal compression fracture (hazard ratio 1.68). The observed 1-year overall survival rate in the resection group was nearly double that of matched historical controls (50.0 vs. 24.8%). We present the largest known series of bony melanoma, along with data which suggest that overall survival may be improved in carefully selected patients where all known macroscopic disease can be resected. Level of evidence: level III. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.