The Role of Surgery in Metastatic Melanoma: A Comprehensive Review of Molecular Characteristics

Hika Choe^*
*Correspondence: Hika Choe, Department of Neuroscience, University of Ohio, Columbus, OH 43210, USA, Email:

Keywords

Metastatic • Implications • Melanoma

Introduction

Melanoma, originating from melanocytes, is notorious for its ability to metastasize early, leading to poor prognosis in advanced stages. Despite significant advancements in systemic therapies, including immunotherapy and targeted therapy, surgical intervention remains crucial in the management of metastatic melanoma. Understanding the molecular characteristics of melanoma has reshaped treatment paradigms, allowing for more personalized surgical approaches tailored to individual patients [1].

Literature Review

Melanoma is a heterogeneous disease characterized by various genetic alterations, including mutations in BRAF, NRAS, and KIT genes, among others. BRAF mutations, particularly V600E, are prevalent in approximately 50% of melanomas and have become a key therapeutic target. NRAS mutations occur in approximately 15-20% of melanomas, while KIT mutations are less common but are associated with acral and mucosal melanomas. Moreover, molecular profiling has identified distinct subtypes of melanoma, such as cutaneous, acral, mucosal, and uveal melanomas, each with unique genomic features and clinical behaviors. Additionally, the tumor microenvironment, immune evasion mechanisms, and interactions with stromal cells play pivotal roles in melanoma progression and response to therapy. Surgical excision of the primary melanoma is the initial step in treatment, aiming for complete removal with negative margins. This reduces the risk of local recurrence and may confer survival benefits, particularly in early-stage disease [2,3].

Discussion

Lymph node involvement is a crucial prognostic factor in melanoma. Sentinel Lymph Node Biopsy (SLNB) allows for accurate staging and facilitates targeted lymphadenectomy in cases of nodal metastasis. Complete Lymph Node Dissection (CLND) may be performed for regional control, although its therapeutic benefit remains debated. Surgical resection of metastatic lesions, termed metastasectomy, is indicated in select patients with limited metastatic disease, preferably in the setting of oligometastases. This approach aims to achieve local disease control, alleviate symptoms, and potentially prolong survival. Metastasectomy may involve resection of pulmonary, hepatic, or other distant metastases, often in combination with systemic therapies. In the era of adjuvant immunotherapy and targeted therapy, the role of adjuvant surgery in metastatic melanoma is evolving. Resection of residual disease following systemic therapy or consolidation surgery after a complete response may be considered in certain cases to minimize the risk of recurrence [3,4].

Techniques such as laparoscopic and robotic-assisted surgery have gained popularity in the resection of metastatic melanoma, offering reduced morbidity, shorter hospital stays, and faster recovery times compared to traditional open approaches. Fluorescence-guided surgery utilizing nearinfrared imaging agents allows for real-time visualization of tumor margins and lymphatic drainage pathways, facilitating more precise resections and lymph node dissections. The adoption of Sentinel Lymph Node Biopsy (SLNB) has revolutionized the management of regional lymph nodes in melanoma, minimizing the morbidity associated with complete lymph node dissection while providing accurate staging information. Intraoperative assessment of surgical margins and lymph nodes using techniques such as frozen section analysis enables immediate decision-making regarding the extent of resection and the need for additional procedures [5,6].

Conclusion

In conclusion, surgery remains an integral component of the multimodal approach to metastatic melanoma, offering both therapeutic and prognostic benefits. Advances in our understanding of melanoma's molecular characteristics have facilitated more personalized surgical strategies, optimizing outcomes for patients with this aggressive malignancy. Continued research efforts aimed at elucidating the complex biology of melanoma and refining surgical techniques are essential for further improving patient outcomes in the future. and refining surgical techniques are essential for further improving patient outcomes in the future.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Wanberg, Connie R., Borbala Csillag, Richard P. Douglass and Le Zhou, et al. "Socioeconomic status and well-being during COVID-19: A resource-based examination."J Appl Soc Psychol 105 (2020): 1382.

   Google Scholar, Crossref, Indexed at

2. Shoji, Kotaro, Roman Cieslak, Ewelina Smoktunowicz and Anna Rogala, et al. "Associations between job burnout and self-efficacy: A meta-analysis."Anxiety Stress Coping 29 (2016): 367-386.

   Google Scholar, Crossref, Indexed at

3. Gardner, Melissa and David E. Sandberg. "Navigating surgical decision making in Disorders of Sex Development (DSD)."Front Pediatr 6 (2018): 339.

   Google Scholar, Crossref, Indexed at

4. Durlak, Joseph A., Roger P. Weissberg, Allison B. Dymnicki and Rebecca D. Taylor, et al. "The impact of enhancing students’ social and emotional learning: A meta‐analysis of school‐based universal interventions." Child Dev82 (2011): 405-432.

   Google Scholar, Crossref, Indexed at

5. Carroll, Annemaree, Stephen Houghton, Robert Wood and Kerrie Unsworth, et al. "Self-efficacy and academic achievement in Australian high school students: The mediating effects of academic aspirations and delinquency."J Adolesc 32 (2009): 797-817.

   Google Scholar, Crossref, Indexed at

6. Judge, Timothy A., Christine L. Jackson, John C. Shaw and Brent A. Scott, et al. "Self-efficacy and work-related performance: The integral role of individual differences."J Appl Soc Psychol 92 (2007): 107.

   Google Scholar, Crossref, Indexed at