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Major amputation for advanced malignant melanoma.

D P Jaques¹, D G Coit, M F Brennan

¹Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.

Surgery, Gynecology & Obstetrics

|July 1, 1989

Summary

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Major amputation for advanced melanoma offered curative intent for some patients, achieving local control and long-term disease-free survival. However, neurovascular involvement and positive resection margins predicted poor outcomes.

Area of Science:

Surgical Oncology
Melanoma Research
Cancer Treatment Outcomes

Background:

Advanced or recurrent malignant melanoma presents significant treatment challenges.
Major amputation has been utilized as a therapeutic option for extensive melanoma.

Purpose of the Study:

To evaluate the outcomes of major amputation for advanced or recurrent malignant melanoma.
To identify prognostic factors influencing survival and recurrence after amputation.

Main Methods:

Retrospective review of 58 patients undergoing major amputation (hemipelvectomy, hip disarticulation, above-knee, or forequarter) for advanced/recurrent malignant melanoma between 1965 and 1984.
Analysis of curative versus palliative amputation cases.
Assessment of patient demographics, disease characteristics, and surgical outcomes.

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Main Results:

Of 43 patients undergoing amputation with curative intent, 30 achieved local disease control. Five-year disease-free survival was observed in 15 of 40 operative survivors.
Neurovascular involvement and positive resection margins were associated with early treatment failure.
For 15 patients receiving palliative amputation, median survival was five months, with all patients succumbing to disease within 33 months.

Conclusions:

Major amputation can achieve local control and long-term disease-free survival in select patients with advanced malignant melanoma.
Prognostic indicators for poor outcomes include neurovascular involvement and positive surgical margins.
Palliative amputation offers limited survival benefit for patients with extensive or fungating disease.