Surgical Management of Stage IV Melanoma: Clinical, Molecular, and Therapeutic Considerations

Despite major advances in systemic therapy, surgery still plays a valuable role in the management of metastatic melanoma. This review summarizes the historical evolution of surgical management, outlines the traditional clinical risk factors, and examines biochemical, molecular, and mutational factors that impact melanoma tumor biology. Emerging tools such as predictive biomarker assays, gene expression profiling, and circulating tumor DNA are discussed in the context of patient selection. Finally, we consider contemporary indications for surgery, the management of oligoprogression, sequence of treatment, and optimal timing of resection while highlighting how operative intervention integrates with modern melanoma care.