In Transit Metastasis as the Presentation of Cutaneous Melanoma

  • Patients presenting with this scenario:
    • Have a 50% to 75% chance of having other distant metastatic disease:
      • So the first step in management:
        • Is to assess for distant disease
      • In the absence of distant disease:
        • In patients with low-volume disease:
          • Resection is indicated:
            • If SNLB has not been performed:
              • SLNB should be strongly considered for prognostic and possible therapeutic benefit (Beasley)
        • Adjuvant treatment with PD-1:
          • Therapy should also be considered:
            • Given results of checkmate 238:
              • Which demonstrated 12-month recurrence-free survival of:
                • 70.5% in resected stage III melanoma patients receiving nivolumab (Weber).
  • References:
    • Beasley GM, Hu Y, Youngwirth L, et al. Sentinel lymph node biopsy for recurrent melanoma: A multicenter study. Ann Surg Oncol. 2017;24:2728-2733.
    • Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;Sept 10.

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