Brief overview of treatment options:
Surgical Resection of Melanoma
The primary treatment for melanoma is surgical resection, typically including a wide local excision of the primary melanoma skin lesion, plus or minus sentinel lymph node mapping and dissection for deeper lesions, plus or minus full regional lymph node dissection, depending upon the pathologic extent of disease (1, 2, 3, 4). For non-cutaneous primary melanoma lesions, such as lesions that arise in the paranasal sinuses, resection plus post-operative radiotherapy seems to give the best result, although high-dose radiotherapy alone may have curative potential in patients who are inoperable (5, 6).
In more advanced cases, selective resection of metastatic lesions (metastectomy) may also increase the disease-free interval (7, 8, 9). Because long-term survivors may be seen at all stages of melanoma, aggressive treatment of primary, regional and limited metastatic disease may be appropriate, depending upon the particular situation (7). Resection of pulmonary lesions has produced a 22% 5-year survival in one reported series, though the authors were unable to ascertain with certainty how many of these were metastatic versus primary lung melanoma lesions (8).
The revised AJCC 6th edition TNM staging system identifies three different levels of metastatic melanoma survival outcomes, with soft tissue/distant lymph nodes most favorable, pulmonary metastases intermediate, and non-pulmonary visceral metastases least favorable, further highlighting the complex natural history of different melanoma presentations (7).
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