Pulmonary metastasectomy for malignant melanoma prolongs survival significantly compared to non-surgical therapy

Pulmonary metastasectomy (PM) is an established treatment for selected patients with pulmonary metastases. While systemic therapies such as immune checkpoint inhibitors, and stereotactic radiation have become standard for unresectable or metastasized melanoma patients, no randomized controlled trials directly assess the benefit of PM by itself in oligometastatic melanoma patients with lung metastases. This retrospective study compares long-term survival outcomes in patients undergoing PM versus those receiving non-surgical therapy for pulmonary metastatic melanoma.

We retrospectively analyzed melanoma patients from the skin cancer center Cologne who were treated with curative intent for their primary tumor and later developed isolated pulmonary metastases. Patients in the non-surgical group had biopsy-confirmed lung metastases. Survival outcomes between patients undergoing PM and those receiving non-surgical therapies were compared.

Between 2012 and 2020, 87 patients met the inclusion criteria: 49 underwent PM and 38 received non-surgical therapy. The number of pulmonary metastases differed significantly between groups (1.27 ± 0.57 vs. 3.2 ± 1.1; p < 0.001). BRAF-mutations were more common in the non-surgical group (35.4% vs. 55.3%; p = 0.04). Patients undergoing PM showed significantly improved 3-year (88.0% vs. 65.7%; p = 0.04) and 5-year survival rates (81.3% vs. 30.8%; p = 0.002) compared to the non-surgical group. Kaplan-Meier analysis confirmed prolonged overall survival in the PM group (log-rank p < 0.02). However, among patients with BRAF mutations, survival did not differ significantly between the groups (p = 0.09).

PM is associated with favorable overall survival. These findings support considering PM as a treatment option in selected patients to improve long-term outcomes.