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Updated: Jul 7, 2025
A 3D Organotypic Melanoma Spheroid Skin Model
Published on: May 18, 2018
Current surgical management for melanoma
Shigeru Koizumi1,2, Takashi Inozume2, Yasuhiro Nakamura1
1Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan.
Abstract:
Melanoma is a major malignant cutaneous neoplasm with a high mortality rate. In recent years, the treatment of melanoma has developed dramatically with the invention of new therapeutic agents, including immune checkpoint inhibitors and molecular-targeted agents. These agents are available as adjuvant therapies for postoperative patients with stage IIB, IIC, and III melanomas. Furthermore, neoadjuvant therapy has been studied in several global clinical trials and has demonstrated promising and favorable clinical efficacy, mainly in patients with palpable regional lymph nodes. A recent large phase III clinical trial investigating early lymph node dissection for sentinel lymph node metastases demonstrated no survival benefits. Based on these data, surgery should be reconsidered as an appropriate treatment modality for melanoma. The need for invasive surgical procedures will be reduced with the invention of effective adjuvant and neoadjuvant therapies and novel clinical trial data on regional lymph node dissection. However, surgery still plays an important role in treating early-stage melanoma, accurately determining the disease stage, and effective palliative treatment for advanced melanoma. In this article, we focus on surgery for primary tumors, regional lymph nodes, and metastatic sites in an era of remarkably revolutionary drug treatments for melanoma.
Insights
Melanoma treatment advances with new drugs, reducing the need for extensive surgery. However, surgery remains crucial for early-stage melanoma, staging, and palliative care in advanced cases.
Area of Science:
- Dermatology
- Surgical Oncology
- Medical Oncology
Background:
- Melanoma is a significant skin cancer with high mortality.
- Recent advances include immune checkpoint inhibitors and molecular-targeted agents for adjuvant therapy.
- Neoadjuvant therapy shows promise, particularly in patients with palpable lymph nodes.
Purpose of the Study:
- To re-evaluate the role of surgery in melanoma treatment.
- To discuss surgical management in the context of novel drug therapies.
- To focus on surgery for primary tumors, lymph nodes, and metastatic sites.
Main Methods:
- Review of recent clinical trial data, including a large phase III trial on lymph node dissection.
- Analysis of the impact of adjuvant and neoadjuvant therapies on surgical indications.
- Discussion of the evolving role of surgery in different melanoma stages.
Main Results:
- A large phase III trial found no survival benefit from early lymph node dissection for sentinel lymph node metastases.
- Effective adjuvant and neoadjuvant therapies are emerging, potentially reducing the need for invasive surgery.
- Surgery's role is shifting, with less emphasis on extensive dissection but continued importance in specific contexts.
Conclusions:
- Surgery's role in melanoma management needs reconsideration due to effective systemic therapies.
- While less invasive procedures may be favored, surgery remains vital for early-stage diagnosis, staging, and palliative care.
- The integration of surgical and systemic treatments is key for optimal melanoma patient outcomes.
