[Does surgery promote the development of metastasis in melanoma?]

Surgery, which is currently the only curative treatment for malignant melanoma, is suspected, in particular presentations, to induce adverse effects such as an increase of metastasis spread. A literature review was performed in order to examine the alleged causes of such phenomena. A medline search covering the 1985-1999 period was performed first. The chosen articles and the study of the references of each of them produced additional articles. The hypothesis is based on the alleged existence of tumor dormancy as micrometastates at an early stage of the disease. Surgery could induce metastasis spread directly by increasing the rate of circulating tumor cells and indirectly above all by disturbing complex mechanisms of tumor regulation such as the balance between activating and inhibiting factors of tumor angiogenesis. Surgery itself as well as the surgical stress could also make easier metastasis spread owing to antitumor immune mechanisms disturbance. Currently, there is no adequate evidence to induce a modified approach in the management of cutaneous melanoma. Surgery remains the mainstay of treatment. However, basic research on angiogenesis and immunity must be carried on.