Surgical management of melanoma lung metastasis: an analysis of survival outcomes in 292 consecutive patients

Background. The role of surgical resection of melanoma lung metastases (MLM) remains controversial. Some authorities advocate an aggressive surgical approach, while others recommend a conservative strategy. This study sought to identify the clinicopathologic and predictors of outcome after surgical management of MLM in a large series of melanoma patients from a single institution. Methods. All patients undergoing surgical management of MLM between November 1984 and April 2010 were identified and predictors of outcome analyzed. Results. Of the 292 patients eligible for the study, 112 (38%) had previously undergone surgery for nonpulmonary recurrences. Four patients (1%) died within 30 days of surgery for MLM. The median progression-free survival time was 10 months. The median overall survival and 3- and 5-year survival were 23 months [95% confidence interval (CI) 17-30], 41 and 34%, respectively. Metastasis size >2 cm [hazard ratio (HR) 1.4, 95% CI 1.0-1.8, P = 0.03, HR 1.6, 95% CI 1.2-2.2; P = 0.002] and positive surgical margin (HR 1.5, 95% CI 1.2-1.9, P<0.001; HR 1.4, 95% CI 1.1-1.7, P = 0.003) were independently associated with poorer progression-free survival and overall survival, respectively. The presence of more than one metastasis (HR 1.4, 95% CI 1.1-1.7, P = 0.013) was independently associated with poorer overall survival. Conclusions. The results support the role of pulmonary metastasectomy in selected patients with MLM. Patients with small (<2 cm) and solitary tumors that can be completely resected with a negative margin are most likely to experience prolonged survival.