Dr. Coit on the Evolving Role of Surgery in Patients With Melanoma

Daniel G. Coit, MD, FACS, surgical oncologist, Memorial Sloan Kettering Cancer Center, discusses the role of surgery in treating patients with melanoma.

As the scope of medication evolves in the treatment of melanoma, so do surgical tactics. Though surgery is becoming deemphasized in patients with positive sentinel nodes, it remains a practical approach. In clinically positive nodes, the role of surgery will evolve as neoadjuvant strategies are integrated into treatment, minimizing the extent of surgery and the attendant morbidity.

In patients with advanced or metastatic disease, there are more opportunities for surgical intervention. Two New England Journal of Medicine articles detailed what happened when patients recurred in clinical trials in an adjuvant setting and in the treatment for advanced disease. In both series, about 20% of patients with relapsed melanoma required surgery for management.

There’s no question that the discovery and approval of novel agents is altering the treatment landscape, but surgery will always be a critical part of the upfront management of the initial diagnosed patient.